Medical Archive

Origins of Uterine Fibroids

Incidence

??? m/c ?? ??. E dependent. ??? ?? ???? ?? ??.

Etiology

Genetics

Hormones

Growth Factors

Risk Factors

Symptoms

??? > bleeding, menorrhagia

Abnormal Bleeding

Endometrial venous ectasia ? heavy menstrual bleeding.
Submucosal/intracavitary fibroids are particularly associated with anemia.

Pain

Urinary Symptoms

Natural History of Fibroids

Rapid Fibroid Growth

Secondary degeneration

??? ?? ??? ???? ????? ?? 

• Hyaline degeneration
  • m/c. ???? ?? ??
• Cystic degeneration
• Calcification
• Necrosis: red degeneration
  • ???? ??? ?? aseptic necrosis
  • Focal pain, tenderness, low grade fever, moderate leukocytosis
  • ???? ????? ?? -> ?? ?? ??? ?? ??

Uterine Sarcoma

Sarcomatous change: 0.5%

Diagnosis

Pelvic Examination

Fibroid Location

Submucosal type (5%)? ulcer, infarction, bleeding? ??

Imaging

• Ultrasound
  • ??? ??? hypo-echoic lesion.
• Sonohysterography
  • Saline infusion ?? ??? ?? ? ??? ? ?? (DOC)

Imaging of Uterine Sarcomas

Fertility

Distortion of the intrauterine cavity can result in reproductive difficulties.

Fibroids and pregnancy

Incidence of Fibroids during Pregnancy

Effect of Pregnancy on Fibroids

Fibroid Degeneration during Pregnancy

• More likely to degenerate during pregnancy b/c myometrial blood flow shifts toward the developing fetus and placenta.
• Red degeneration
  • ?? ?? hemorrhagic infarction
  • Severe pain, tenderness, fever
• Ultrasound
• Conservatively managed with acute pain control
  • eg, indomethacin for patients <32 weeks gestation
  • codein ???? ??.

In?uence of Fibroids on Pregnancy

Treatment

Watchful Waiting

Medical Therapy

• NSAIDs
  • ????? ?? ??????? ????? ??.
• GnRH agonist
  • ?? ??, ?? ?? ??
  • Hypoestrogen state? ???? ????, ????, ???? ????? (?? ? 40-60% ??)
• Mifepristone, Mirena

Surgical Treatment Options

Indications

• ????? ?? anemia? ???? GnRH agonist? ?? ?? ?
• ?? ???? ?? chronic pain
• Acute pain
• ?? ??: hydronephrosis
• ?? ??
  • ?? ?: ??? ???? ?? ?
  • ?? ?: ??? ????? ?? ? (sarcomatous change ???? ???)

????? ?? ??(10%). ?? ?? ???? ??? (bleeding ?)

Sarcomas

• Endometrial stromal sarcoma (ESS)
  • ??? endometrium ????? curettage? ?? 
  • Treatment
    • Stage I (uterus? ??): TAH+BSO
    • Stage II (within pelvis): TAH+BSO
    • Stage III (abdominal tissues): TAH+BSO+RTx+CTx
    • Stage IV (bladder or rectum): CCRT
    • High grade: >10mitosis/10HPF, high grade???? progestin ?? O
• Leiomyosarcoma (LMS)
  • ?? ? ??? TAH±BSO(?????)
  • Stage III ??? TAH+BSO+CTx+(RTx)
• Malignant mixed müllerian tumor (MMMT)
  • sarcoma + carcinoma. RF:?? ?? ??? ???
  • ?? ? uterine curettage? ??
  • ??? ?? ???? ??. ?? ??TAH+BSO? ??. 
  • CTx? doxorubicin, ??? 25%?. ? ??? ??.

Treating Preoperative Anemia

Abdominal Myomectomy

Laparoscopic Myomectomy

Adhesions Following Myomectomy

Hysteroscopic Myomectomy

?? submucosal myoma? hysteroscopic resection

Endometrial Ablation for Abnormal Bleeding Associated with Fibroids

New Appearance of Fibroids

Clinical Follow-Up

Prognostic Factors Related to New Appearance of Fibroids

Uterine Artery Embolization

Uterine Artery Embolization Technique

Uterine Artery Embolization Outcomes

Uterine Artery Occlusion

Magnetic Resonance–Guided Focused Ultrasound

Management Summary