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    Myoma Utrei: Gynecology Department

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    D.A.B.M
    This document provides an overview of myoma uteri (uterine fibroids). It discusses the epidemiology, anatomy, pathology, risk factors, signs and symptoms, complications, diagnosis and treatments. Uterine fibroids are noncancerous tumors that originate from the smooth muscle of the uterus. They are common among women during childbearing years. While many fibroids cause no symptoms, they can sometimes cause heavy bleeding, pain, or infertility. Diagnosis involves physical examination, ultrasound, MRI or other imaging tests. Treatment options include medication, surgery such as myomectomy or hysterectomy, or lifestyle changes.

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    Myoma Utrei: Gynecology Department

    Uploaded by

    D.A.B.M
    36 views33 pages
    This document provides an overview of myoma uteri (uterine fibroids). It discusses the epidemiology, anatomy, pathology, risk factors, signs and symptoms, complications, diagnosis and treatments. Uterine fibroids are noncancerous tumors that originate from the smooth muscle of the uterus. They are common among women during childbearing years. While many fibroids cause no symptoms, they can sometimes cause heavy bleeding, pain, or infertility. Diagnosis involves physical examination, ultrasound, MRI or other imaging tests. Treatment options include medication, surgery such as myomectomy or hysterectomy, or lifestyle changes.

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    This document provides an overview of myoma uteri (uterine fibroids). It discusses the epidemiology, anatomy, pathology, risk factors, signs and symptoms, complications, diagnosis and treatments. Uterine fibroids are noncancerous tumors that originate from the smooth muscle of the uterus. They are common among women during childbearing years. While many fibroids cause no symptoms, they can sometimes cause heavy bleeding, pain, or infertility. Diagnosis involves physical examination, ultrasound, MRI or other imaging tests. Treatment options include medication, surgery such as myomectomy or hysterectomy, or lifestyle changes.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    36 views33 pages

    Myoma Utrei: Gynecology Department

    Uploaded by

    D.A.B.M
    This document provides an overview of myoma uteri (uterine fibroids). It discusses the epidemiology, anatomy, pathology, risk factors, signs and symptoms, complications, diagnosis and treatments. Uterine fibroids are noncancerous tumors that originate from the smooth muscle of the uterus. They are common among women during childbearing years. While many fibroids cause no symptoms, they can sometimes cause heavy bleeding, pain, or infertility. Diagnosis involves physical examination, ultrasound, MRI or other imaging tests. Treatment options include medication, surgery such as myomectomy or hysterectomy, or lifestyle changes.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 33

    Myoma utrei

    Gynecology department

    DONE BY :
    MUSTAFA KHALIL IBRAHIM
    TBILISI STATE MEDICAL UNIVERSITY
    4th year, 2nd semester, 1st group
    Epidemiology
    Anatomy
    Introduction
    Pathology
    Pathophysiology
    Risk factors
    Etiology
    Signs and symptoms
    Complications
    Diagnosis
    Treatments
    Prevention
    References
     The most common non-cancerous tumours in women .
     The most common indication for hysterectomy.
     Apparent in up to 25% of women.
     More common in a higher body mass index women.
     3 times more common in black American women than white
    women.
     Asian women have a lower incidence .
     Symptoms appear at age of 30s or 40s .
     The incidence increases with age up to the menopause.
     Women over the age of 30 are commonly affected by fibroid
    uterine.
     50% of all women are affected by fibroid uterine.
     Most common solid pelvic tumors.
     Develop in 20 ～ 25% of women during reproductive years.
    Uterine fibroids are noncancerous growths of the
    uterus that often appear during childbearing years.
    A benign tumors of the smooth muscle cells of the
    uterus
    Uterine fibroid is a leiomyoma (benign (non-
    cancerous) tumor from smooth muscle tissue) that
    originates from the smooth muscle layer (myometrium) of
    the uterus
    They can grow as a single tumor or as a cluster.
    Myoma

    Uterine
    Fibrole-
    fibromy
    iomyoma
    oma

    Uterine
    fibroid Fibroma
    s

    Fibroids
    GROSS APPEARANCE
    Rare only a single ， usually many exist
    Well-circumscribed ， nonencapsulated
    A pseudocapsule is present.
    The consistency is usually firm or even hard except when
    degeneration or hemorrhage has occurred.
    color ： light gray or pinkish white
    cut section ： an intertwining pattern or
    a whorl-like arrangement ；
    bulgy
    Smooth muscle tumors of the uterus are often
    multiple. Seen here are submucosal, intramural,
    .and subserosal leiomyomata of the uterus
    Microscopic Appearance

    Composition ： smooth muscle


    connective tissue

    The nonstriated muscle fibers are arranged in bundles


    of various sizes that run in multiple directions.
    Exact etiology is unclear
    Hormonally responsive to estrogen; grow
    during pregnancy and regress with
    menopause
    May outgrow blood supply and degenerate
    causing pain
    According to growth location ：

     Myomas on the body of uterus （ 90% ）


     Myomas on the cervix of uterus （ 10% ）

    According to position
     70 % Intramural
    (in uterine wall)

     20% Subserosal
    (beneath serosa)

     10 % Submucosal
    ( beneath endometrium )
    pedunculated submucosal or
    pedunculated vaginal
    Cellular leiomyoma (composed of densely cellular fascicles of smooth
    muscle with little intervening collagene).
    Atypical leiomyoma (containing atypical cells, clustered or distributed
    through the lesion).
    Epithelioid leiomyoma (composed of round or poligonal cells rather than
    spindle-shaped. This subtype includes leiomyoblastoma, clear cell leiomyoma,
    plexyform leiomyoma).
    Myxoid leiomyoma (containing abundant amorphous myxoid substance
    between the smooth muscle cells).
    Vascular leiomyoma (containing dense proliferations of large, caliber, thick-
    walled vessels).
    Lipoleiomyoma (consisting of a mixture of mature adipocytes and smooth
    muscle cells).
    Leiomyoma with tubules (containing tubular structures).
    Benign metastasizing leiomyoma (occurrence of multiple smooth-
    muscle nodules, most often located in the lung after previous hysterectomy).
    SECONDARY CHANGES IN FIBROID
    Degenerative changes
    Hyaline degeneration:
    Cystic degeneration:
    Calcification:
    Fatty degeneration:
    Red degeneration: with fever, pain
    and vomiting
    Septic degeneration:
    Infection
    Atropy
    Necrosis
    Vascular changes
    Sarcomatous changes
    Heredity.
    Race. 
    Pregnancy and childbirth. 
    Nulliparity Obesity
    Oral contraceptives. 
    unknown.
    Family history
    Genetic alterations. 
    Hormones. 
    Other growth factors: 
    such as insulin-like growth factor, may affect
    fibroid growth.
    • Half of women with fibroids have no
    symptoms
    • symptoms depends on their size, position
    and condition

    menorrhagia and prolonged menstrual period ： common


    Pelvic pain ：
    occurs in pregnancy if undergoing degeneration or torsion of
    a pedunculated myoma
    Pelvic pressure ： urinary frequency
    bowel difficulty （ constipation ）
    Spontaneous abortion
    Infertility
    Others :

    (Constipation, Backache or leg pains…etc)


     Hypermenorrhea (submucosal are more likely) .
     Persistent intermenstrual bleeding (cause by pedunculated
    submucosal fibroid)
     Dyspareunia (cause by torsion of a pedunculated fibroid)
     abdominal cramps, discomfort, and heaviness( cause by large
    uterus)
     Constipation and urinary frequency (cause by pressure)
     Recurrent miscarriage or infertility
     Recurrent miscarriage
     Fetal malpresentation
     Red degeneration: presents with
    fever, pain and vomiting
     Intrauterine growth retardation
     Premature labour
     Postpartum haemorrhage
     A c-section may be needed
    Menorrhagia.
    Abdominal pains 
    Infertility 
    Leiomyosarcoma 
    Twisting of the fibroid
    Anemia
    Urinary tract infections
     Vital signs
     Heart rate .
     Blood pressure.
    Physical examination  Breathing.
     Temperature.
    • Abdominal examination  BMI.

    • Feel is firm more towards hard may be  O2 saturation

    cystic in cystic degeneration.


    • Margins are well defined except the lower
    pole.
    • nodular may be uniformly enlarged
    • Mobility is restricted from above
    downwards but can be moved from side to
    side.
    • Percussion : swelling is dull
    Pelvic examination
    Bimanual examination reveals
    uterus irregularly enlarged
    Uterus is not felt separated
    from the swelling and as such
    . groove is not felt between the
    uterus and the mass.
    The cervix moves with the
    movement of the tumour felt
    per abdomen.
    Laboratory Tests
    Blood test (CBC) .
    -Rbc, Iron, Erthropoietin, Hematocrit,Wbc …. etc
    Hormonal test
    Estrogen-
    Pregnancy test may be indicated:
    Gonadotropin chorionic-
    Hys
    tero
    sco
    py

    Hys
    tero
    son
    o gra Hysterosalpingography
    phy
    CT Scan
    MRI
    DIFFERENTIAL DIAGNOSIS
    Chronic pelvic inflammatory disease
    Tubo-ovarian abscess
    Ovarian tumour
    Uterine sarcoma
    Endometrial polyps, endometrial carcinoma
    Endometriosis
    Dysfunctional uterine bleeding
    Other causes of a pelvic mass include tumour of large
    bowel, appendix abscess, diverticular abscess
    Pregnancy
    MEDICATIONS
     NSAID.
    SURGERY  Antifibrinolytic agents.
     Combined oral
    Myomectomy contraceptive.
    Hysterectomy  Danazol.
     GnRH agonists.
    Beware of side effects including amenorrhoea,
    menopausal symptoms and osteoporosis in long
    term use.
    Hysterectomy
    healthy lifestyle
     Exercise regularly.
     Manage your weight. 
     Drink green tea or use green tea extract.
     Consider changing your diet.
     Understand that pregnancy and childbirth may
    have protective effects against developing uterine
    fibroids.
    BOOKS :
    Current Diagnosis And Treatments In Obstetrics,
    Gynecology 10Th Ed.
    Williams Gynecology, Third Edition 3rd Edition 2016 .
    INTERNET :
    Mayo clinic .
    Medscape .
    Center of disease and control .
    World health organization .
    http://atlasgeneticsoncology.org/Tumors/leiomyomID
    5031.html
    ‫‪MADLO‬‬
    ‫‪BA‬‬

    ‫جـزيـ ًالـ‬
    ‫َـــ‬ ‫شــًـكراـ‬

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