Download Uterine Myoma

Uterine Myoma
Women’s Hospital, School of Medicine Zhejiang
University
Prof. Lin Jun
Introduction
 Most common benign tumor of female
reproductive system
 Benign neoplasm composed primarily of
smooth muscle and connectives tissue
 Common in women 30-50y
 Usually asymptomatic
Etiology
Not detectable before puberty and after
menopause
Probably relates to female hormones
Estrogen and ER ↑
Progestin may promote mitosis of
myoma
Classification
According to the location：
 Uterine body myoma
 Cervical myoma
10%
90%
Classification
According to the relationship between
myoma and uterine myometrium ：
 intramural myoma
60%-70%
 subserous myoma
20%
 submucous myoma 10%-15%
Classification
Classification
multiple myoma
Pathology
Gross Appearance：
 round, smooth, and usually firm
 false capsular covering ——pseudocapsule
can be clearly demarcated from the surrounding
myometrium
Pathology
Gross Appearance：
Transverse section :
 light gray
 a whorl-like arrangement or an intertwining
pattern
Pathology
Microscopic examination：
 composed of smooth muscle cells and varying
amounts of connectives tissue
 Individual cells are quite uniform in size, spindle
shaped, have elongated nuclei.
 Nonstriated muscle fibers are arranged in interlacing
bundles of varying size running in different
directions.
Degeneration
 Hyaline degeneration
 Cystic degeneration
 Red degeneration
 Sarcomatous change
 Degeneration with calcification
Degeneration
Red degeneration
 most common during pregnancy and
puerperium
 venous thrombosis and congestion with
interstitial hemorrhage
Degeneration
← Red degeneration
← Hyaline degeneration
Degeneration
Sarcomatous change
 malignant
 rare, 0.4-0.8%
 old women
 enlarge rapidly with irregular vaginal
bleeding
Degeneration
Sarcomatous change
Symptoms
 Usually no symptoms
 Associate with location, and degenerations
 Not associate with the size and the number
Symptoms
1. menorrhagia and prolonged menses
 large intramural myoma
 submucous myoma
2. abdominal mass
3. leukorrhagia
Symptoms
4. pressure effects
 pressure bladder or rectum
→
urinary frequency,
constipation
 intraligamentous myoma and large cervical myoma →
obstruct ureter
5.others
 infertility
 spontaneous abortion
 abdominal pain
Sign
associated with：
 size
 location
 number
 degeneration
large myoma→ palpable abdominal mass
Pelvic examination：
uterus —— enlarged，irregular and hard
Diagnosis
 Typical symptoms and signs
 Ultrasound
 Hysteroscopy
 Laparoscopy
Ultrasound
Ultrasound
Diagnosis
Hysteroscopy
Diagnosis
Laparoscopy
Differential diagnosis
 Pregnancy
 Ovarian neoplasms
 Adenomyosis
 Malignant tumors of uterus
 uterine sarcoma
 endometrial carcinoma
 cervical cancer
Treatment
According to :
 age
 desire for childbearing
 symptoms
 location , size and amount of myoma
Treatment
Observation and Follow Up
 Small，asymptomatic，especially near
menopause
 Interval：3～6 months
Medical measure
Indications：
 smaller than 2 months in size
 slight symptoms
 near menopause
Medical measure
1.Androgenic agents：
testosterone propionate
2.Gonadotropin-releasing hormone agonist, （GnRH-a）
GnRH-a
LH、FSH↓
E2↓
shrinkage of myoma
 leuprorilin
 goserelin
Medical measure
2.GnRH-a
Side effects:
Hypoestrogenic side effects
Osteoporosis
3.Mifepristone
Surgical measures
Indications：
 greater than 10 weeks in size
 menorrhagia→ anemia
 pressure effects
 grows rapidly
 failure in medical treatment
 infertility or recurrent abortion
Surgical measures
Approaches：
laparotomy
hystereoscopy
laparoscopy
Surgical measures
1. Myomectomy
 preserve fertility, <35 years old
2. Hysterectomy
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Large myoma
Numerous tumors
Obviously symptomatic patient
No wish of preserving fertility
Suspected to malignant transformation
Myomas during pregnancy
Impact on pregnancy and delivery ：
 abortion
 preterm labor
 fetal malpresentation
 placenta previa
 birth canal obstruction
 postpartum hemorrhage
Myomas during pregnancy
Red degeneration
Clinical finding:

rapid growth of myoma

pain, fever, WBC↑
Conservative treatment