Uterine Leiomyoma Maria Maples, M3

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Uterine LeiomyomaMaria Maples, M3
leiomyomata
Uterine fibroids
myoma
fibromyoma
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Uterine Leiomyoma

• Benign neoplasm of smooth muscle
• Estrogen sensitive
• Surrounded by pseudocapsule
• Rare malignant potential (Leiomyosarcoma)

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Location
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Leiomyoma
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Leiomyosarcoma
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Prevalence

• 20-30 of reproductive-age women
• Most common indication for surgery in U.S. women
• 1/3 of all hysterectomies
• 3-fold higher incidence rate in Black women 1,2

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Risk factors

• African American
• Nonsmoking
• Obese
• Perimenopausal
• Gene mutations

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Genetic basis?

• Twin studies 3
• First-degree affected relatives 4,5
• Race as risk factor
• Hereditary Leiomyomatosis and Renal Cell
  Carcinoma (HLRCC) 6
• Cutaneous and uterine leiomyomata
• At risk for papillary renal cell carcinoma (women
  gt men) 7,8
• Women increased risk of leiomyosarcoma 7,8
• Mutation in fumarate hydratase gene

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Signs and Symptoms

• Bleeding
• Pressure
• Pain
• Infertility
• Pregnancy complications cesarean delivery,
  breech presentation, malposition, preterm
  delivery, placenta previa, severe postpartum
  hemorrhage 9
• 50-60 Asymptomatic

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Diagnosis

• History
• Bimanual pelvic or abdominal exam
• Pelvic ultrasound - most common
• MRI, HSG, sonohystogram, hysteroscopy

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Treatment

• Expectant management - most cases
• Indications for treatment
• Abnormal uterine bleeding, causing anemia
• Severe pelvic pain
• Large or multiple
• Obscuring evaluation of adnexae
• Urinary tract symptoms
• Postmenopausal or rapid growth

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Treatment Choices

• Medical therapies
• Medroxyprogesterone (Provera)
• Danazol
• GnRH agonists (nafarelin acetate, Depot Lupron)

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Treatment Choices

• Myomectomy
• Hysteroscopically
• Laparoscopically
• Abdominally

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Treatment Choices

• Uterine Artery Embolization (UAE)

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Treatment ChoicesMR guided Focused Ultrasound
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Treatment Choices

• Hysterectomy
• Vaginal
• Abdominal

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Gene Therapy

• Gene-based vectors 13
• Dominant-negative form of estrogen receptor to
  inactivate estrogen signaling and induce
  apoptosis 13

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Follow-up (Treatment)

• Monitor size and location of fibroids
• Indications for treatment
• Abnormal uterine bleeding, causing anemia
• Severe pelvic pain
• Large or multiple
• Obscurrng evaluation of adnexae
• Urinary tract symptoms
• Postmenopausal or rapid growth

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References

• 1Marshall LM, Spiegelman D, Barbieri RL, Goldman
  MB, Manson JE, Colditz GA, et al. Variation in
  the Incidence of uterine leiomyoma among
  premenopausal women by age and race. Obstet
  Gynec 199790967-73.
• 2Kjerulff KH, Langenberg P, Seidman JD, Stolley
  PD, Guzinski GM. Uterine leiomyomas racial
  differnces in serverity, symtoms and age at
  diagnosis. J Reprod Med 199641483-90.
• 3Sneider H, MadGregor AJ, Spector TD. Genes
  control the cessation of a womens reproductive
  life a twin study of hysterectomy and age at
  menopause. J Clinical Endo Metab
  19981831875-80.
• 4Vikhlyaeva EM, Khodzhaena ZS, Fantschenko, ND.
  Familial predisposition to uterine leiomyomas.
  Int Gynaecol Obstet 1995 51127-31.

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References

• 5VanVoorhis BJ, Romitti PA, Jones MP. Family
  history as a risk factor for development of
  uterine leiomyomas. Results of a pilot study. J
  Reprod Med 2002 47663-9.
• 6 Stewart, EA, Morton CC. The genetics of
  uterine leiomyomata what clinicians need to
  know. Obstet Gynecol 2006 April 107(4)917-21.
• 7Launonen V, Vierimaa O, Kiuru M, Isola J, Roth
  S, Pukkala E, et al. Inherited suseptibility to
  uterine leiomyomas and renal cell cancer. Proc
  Natl Acad Sci USA 2001983387-92.
• 8Toro JR, Nickerson ML, Wei MH, Warren MB, Glenn
  GM, Turner ML, et al. Mutations in the fumarate
  hydratase gene casue hereditary leiomyomatosis
  and renal cell cancer in families in North
  America. Am J Hum Genet 20037395-106.

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References

• 9Oidwai GI, Caughey AB, Jacoby AF. Obstetric
  outcomes in women with sonagraphically identified
  uterine leiomyomata. Obstet Gynecol 2006 Feb
  107(2 Pt1)376-82
• 10Stewart,EA, Rabinovici, Tempany CMC, Inbar Y,
  Regan L, Gastout, B, Hesley G, Kim HS, Hengst S,
  Gedroye WM. Clinical outcomes of focused
  ultrasound surgery for the treatment of uterine
  fibroids. Fertil Steril 2006 Jan85(1)22-29.
• 11Huang JY, Kafy S, Dugas A, Valenti D, Tulandi
  T. Failure of uterine fibroid embolization.
  Fertil Steril 2006 Jan85(1)30-35.