Updated: 10/12/2018

Leiomyoma (Fibroids)

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
Topic
https://upload.medbullets.com/topic/120456/images/fibroids.jpg
Snapshot
  • A 33-year-old G4P4 female complains of abnormal vaginal bleeding that occurs intermittently between her predictable menstrual cycles. A transvaginal ultrasound shows suspicious hyperechoic masses within the uterine wall. A laparoscopic procedure is performed to assess the anatomy further.
Overview
 
Introduction
  • Otherwise known as fibroids
  • Leiomyomas are smooth muscle growths of the uterine myometrium can be
    • intramural
    • submucosal
    • subserosal
  • Epidemiology (most common)
    • benign uterine tumor
    • tumor in females
    • seen in African Americans (5x more common)
    • occurs in women aged 20-40 years of age
  • Often present with multiple discrete tumors
Presentation 
  • Symptoms
    • sensitive to estrogen levels
      • tumor growth and increased symptoms during pregnancy
      • decreased symptoms during menopause
        • note, if symptoms increase after menopause, the diagnosis is likely not fibroids
    • symptoms depend on location of leiomyoma
      • intramural
        • asymptomatic
      • submucosal
        • intermenstrual bleeding and menorrhagia
      • subserosal 
        • compression of bladder, rectum, or ureter
          • pelvic pain
          • urinary or bowel issues
  • Physical exam
    • uterus is
      • enlarged
      • firm
      • mobile
      • asymmetric
      • nontender
      • multiple tumors
Evaluation
  • Diagnose with clinical history and exam
  • Confirm with sonogram
    • transvaginal ultrasound has high sensitivity (95-100%)
    • hyperechoic, well-circumscribed round masses
  • Labs
    • β-hCG to rule out pregnancy
  • Histology
    • whorled pattern of smooth muscle bundles
Differential Diagnosis
  • Leiomyosarcoma
  • Adenomyosis
  • Endometrial polyp
  • Pregnancy
Treatment
  • If asymptomatic
    • observation
      • fibroids can shrink substantially postpartum and after menopause
  • If symptomatic
    • NSAIDs for dysmenorrhea
    • OCPs for abnormal uterine bleeding
    • GnRH analogs to shrink fibroids pre-surgery
    • surgical management
      • myomectomy
        • reserves childbearing potential
      • uterine artery embolization
        • preserves childbearing potential if myomectomy is not an option
      • hysterectomy
        • definitive therapy
Prognosis, Prevention, and Complications
  • Prognosis
    • having symptomatic fibroids decreases quality of life
  • Complications
    • very rarely (if at all) transforms into leiomyosarcoma
    • infertility
 

 

Please rate topic.

Average 5.0 of 1 Ratings

Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
EXPERT COMMENTS (0)
Private Note