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Fibroid uterus


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Fibroid uterus

  1. 1. FIBROID UTERUS (Synonyms : Myoma, Leiomyoma, Fibromyoma) Most common benign neoplasm in the female.Fibroid is not only the commonest benign tumor of the uterus but is the commonest benign solid tumor in female histologically this tumor is imports of smooth muscle and fibrous connective tissue so so that named as uterine leiomyomamyoma or fibromyoma Incidence It has been estimated that at least 20% of women at the age of 30 have got fibroid in there womb. Most of them remain asymptomatic the incidence of symptomatic fibroid in hospital outpatient is about 3% a incidents of 10% prevalence in England. These are more common in nulliparous or in having one child in fertility. Etiology  Chromosomalabnormality in about 40% of cases there is chromosomal abnormality chromosome6 or 7 (rearrangement , deletion)  Role of polypeptide growth factors epidermal growth factor insulin like growth factor 1 transforming growth factor stimulate the growth of leiomyoma directly or via estrogen  Oestrogen dependent tumor. Risk of fibroid tumor  Nulliparity  Obesity  Hyperestogenic state  Black women  Prog.only contraceptives  cigarette smoking  age 35 to 45 years Type 1. Body  Intramural  Subperitoneal
  2. 2.  Subserous  Broad ligament  Wandering  Submucous  Sessile  Pedunculated 2. Cervical  Anterior  Posterior  Central  Lateral Pathology Nakedeye appearance 1) The uterus is enlarge the shape is distorted by multiple nodular growth of varying sizes there may be uniform and enlargement of the uterus by a single fibroid the feel is firm. 2) Cut surface of the tumor is smooth and white 3) The false capsule is formed by the compressed adjacent myometrium they have more parallel arrangement and are pink in colour in contrast to whitish appearance of the tumor. Microscopicapperance The tumor consist of smoothmuscles and fibrous connective tissue of varying proportion It consists of only muscles element but later on fibrous tissue intermingle with the muscles bundle Secondarychanges in fibroid  Degeneration  Atrophy  Necrosis  Infection  Vascular changes  Sacromatouschanges
  3. 3. Clinical features  The patient usually nulliparous for having long period of secondary infertility  Abnormal menstrual o Menorrhagia o Metrorrhagia o Dysmenorrhea Dyspareunia Infertility Pressure symptoms Miscarriage Lower abdominal or pelvic pain Abdominal enlargement Complications of Fibroids 1) Atrophy. 2) Necrosis. 3) Degeneration. 4) Malignancy- Risk of Malignancy 0.1% in reproductive age group 1.7% after age of 60 years 5) Infection. 6) Torsion. 7) Incarceration. 8) Inversion of the uteruss. Diagnosis Clinical : From symptoms & signs USG : Well defined hypoechoic lesions. Peripheral calcification with distal shadowing in old fibroids. TAS differentiates the tumour from other swellings as ovarian tumoursize, site and number of fibroids Saline infusion sonography HysteroscopyTo visualize a sub mucous fibroid or a small fibroid polyp. Intra venous pyelogram (IVP) In cervical and broad ligament fibroid Course of ureter, Hydroureter & hydroneprosis , Kidney function. MRI : Most accurate imaging modality for diagnosis of fibroid. It does precise fibroid mapping & Detects small myomas(0.5 cm) H S G : Not done for diagnosis , Done for infertility evaluation filling defects may be seen
  4. 4. Management Expectant : asymptomatic , Size < 12 weeks, near menopause . • Regular follow up every 6 months • Recent guidelines suggest upto 16 wks size however difficult to practice Medical Management • Not a definitive Rx • Forsymptomatic relief • Preoperatively to decrease the size • Progestogens, antiprogestogens ( Miefpristone ) androgens ( Danazol, Gestrinone ) & GnRH analogues are used GnRH analogues /Agonists are commonly used drugs :- • Triptorelin ( Decapeptyl) 3.75 mg or leuprolide depot 3.75 mg I/M or Goseraline ( Zoladex) 3.6 mg SC for 3 months Disadvantages : High costHypoestrogenic side effects Effect is reversible Rarely ↑ bleeding due to degeneration Occasionally difficulty in enucleation Antagonist Cetrorelix is used 60 mg I/M repeated after 3-4 months if necessary Initial flare up does not occur SurgicalManagement Increases Hb Level Decreases Blood Loss During Surgery Converts Hysterectomy Into Myomectomy  Laproscopic  Hysteroscopic  Vaginal  Abdominal  Myomectomy  Vaginal  Abdominal  Hysterectomy