Leiomyoma, Uterus (Fibroid)

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Leiomyoma, Uterus (Fibroid)
By
Ali azizi Alborz hedayati
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Leiomyoma, Uterus (Fibroid)
Leiomyomas are benign tumors of the uterus
Arise from the overgrowth of smooth muscle and
connective tissue in the uterus
A genetic predisposition exists
Femalegt30(25-50)
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Leiomyoma, Uterus (Fibroid)
Evidence of an apparent hormonal dependency
includes the following
1-Estrogen and progestin receptors are present
in fibroids 2-Elevated estrogen levels may cause
fibroid enlargement. During the first trimester
of pregnancy, 15-30 of fibroids may
enlarge and then shrink in
puerperium. Some fibroids may decrease
in size during pregnancy 3-Fibroids shrink after
menopause .y 4-Some regrowth may occur with
hormonal therap
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Leiomyoma, Uterus (Fibroid)
Complications during pregnancy include

1. Spontaneous abortion
2. Intrauterine growth retardation
3. Preterm labor
4. Uterine dyskinesia
5. Inertia during labor
6. Obstruction of the birth canal
7. Postpartum hemorrhage
8. Hydronephrosis

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Leiomyoma, Uterus (Fibroid)
Anatomy
Most leiomyomas occur in the fundus and body of
the uterus only 3 occur in the cervix. The
fibroids may be solitary, multiple, or diffuse
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There are three primary types of uterine
fibroids, classified primarily according to
location in the uterus
Leiomyoma, Uterus (Fibroid)
There are three primary types of uterine
fibroids, classified primarily according to
location in the uterus
These fibroids develop in the outer portion of the uterus and continue to grow outward Subserosal uterine fibroids
The most common type of fibroid. These develop within the uterine wall and expand making the uterus feel larger than normal (which may cause "bulk symptoms) Intramural uterine fibroids
These fibroids develop just under the lining of the uterine cavity. These are the fibroids that have the most effect on heavy menstrual bleeding and the ones that can cause problems with infertility and miscarriage Submucosal uterine fibroids
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Leiomyoma, Uterus (Fibroid)
Clinical Details
Most women with fibroids are asymptomatic. Only
10-20 of patients require treatment
Fibroid symptoms are related to the number of
tumors, as well as to their size and location

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Bleeding (Menorrhagia)(Most common)
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Pain
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Pressure
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Leiomyoma, Uterus (Fibroid)
Bleeding (Menorrhagia)(Most common)
Menorrhagia may result in severe anemia and can
be life threatening, although this is rare.
Menorrhagia usually results from the erosion of a
submucosal fibroid into the endometrial cavity.
Rarely, dilated veins on the surface of a
subserosal, pedunculated fibroid can cause
sudden, massive intraperitoneal bleeding
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Leiomyoma, Uterus (Fibroid)
Pain
Women may experience abdominal cramping. Pain
usually is felt during menstruation. Less often,
pain occurs intermenstrually
Pressure
Urinary frequency, urgency, and/or incontinence
result from pressure on the bladder
Constipation, difficult defecation, or rectal
pain results from pressure on the colon
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Leiomyoma, Uterus (Fibroid)
Differential diagnosis
Normal ovary - May be confused with fibroids at
US Ovarian mass - Hemorrhagic cyst,
endometrioma, dermoid, cystadenoma, malignant
tumor Uterine leiomyosarcoma - Rare, arise de
novo or as a result of the malignant

degeneration of a
uterine fibroid Adenomyosis - May be difficult
to distinguish from multiple small fibroids
Myometrial contraction - Especially during
pregnancy Necrotic fibroids - May mimic
intrauterine gestational sac, intrauterine fluid
collection,
hydatiform mole
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Leiomyoma, Uterus (Fibroid)
Radiogrph findings
Conventional radiographs have a limited role in
the diagnosis of uterine fibroids
Unless heavily calcified, fibroids are not
depicted on radiographs
CT findings
CT scanning has a limited role in the diagnosis
of uterine fibroids
On CT scans, fibroids are usually
indistinguishable from healthy myometrium unless
they are calcified or necrotic
Calcifications may be more visible on CT scans
than on conventional radiographs because of the
superior contrast differentiation with CT scanning
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Leiomyoma, Uterus (Fibroid)
Sonography
US is the imaging modality of choice in the
detection and evaluation of uterine fibroids
The most frequent US appearance is that of a
concentric, solid, hypoechoic mass
These solid masses absorb sound waves
and therefore cause a variable amount of acoustic
shadowing
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Leiomyoma, Uterus (Fibroid)
Sonogram shows the subserosal, 2.3- to 2.5-cm,
right anterior fundal uterine fibroid
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Leiomyoma, Uterus (Fibroid)
They can be heterogeneous or hyperechoic,
depending on the amount of fibrous tissue and/or
calcification
Sagittal sonogram shows a posterior, fundal, 4.2
X 3.5-cm intramural uterine fibroid
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Leiomyoma, Uterus (Fibroid)
CT scan shows a subserosal, 2.3- to 2.5-cm, right
anterior fundal uterine fibroid
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Leiomyoma, Uterus (Fibroid)
MRI findings
MRI has an important role in defining the anatomy
of the uterus and ovaries
Fibroids are sharply marginated areas of
low-to-intermediate signal intensity on T1- and
T2-weighted MRI scans
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Leiomyoma, Uterus (Fibroid)
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Leiomyoma, Uterus (Fibroid)
One third of fibroids have a hyperintense rim on
T2-weighted images as a result of dilated veins,
lymphatics, or edema.
Sagittal T2-weighted MRI shows that the largest
fibroid is located in the lower uterus and has a
partially hyperintense rim. A smaller discrete
fibroid is depicted in the fundus
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Leiomyoma, Uterus (Fibroid)
Axial MRI shows the cross section of the larger
fibroid in the lower uterus. Note the mass
effect on the bladder, which is located
anteriorly
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Leiomyoma, Uterus (Fibroid)
An inhomogeneous area of high signal intensity
may be depicted on T2-weighted images this
results from hemorrhage, hyaline degeneration,
edema, or highly cellular fibroids
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Leiomyoma, Uterus (Fibroid)
The intravenous administration of
gadolinium-based contrast material usually is not
required
if it is administered, fibroids usually enhance
later than does the healthy myometrium. Fibroid
enhancement can be hypointense (65), isointense
(23), or hyperintense (12) in relation to that
of the myometrium
MRI has a sensitivity of 86-92, a specificity of
100, and an accuracy of 97 in the evaluation of
probable fibroids
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Thank you
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