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(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
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.
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
age 35 to 45 years
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.
The tumor consist of smoothmuscles and fibrous connective tissue of
It consists of only muscles element but later on fibrous tissue intermingle
with the muscles bundle
Secondarychanges in fibroid
The patient usually nulliparous for having long period of secondary
Lower abdominal or pelvic pain
Complications of Fibroids
4) Malignancy- Risk of Malignancy 0.1% in reproductive age group 1.7% after
age of 60 years
8) Inversion of the uteruss.
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 tumoursize, 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
asymptomatic , Size < 12 weeks, near menopause .
• Regular follow up every 6 months
• Recent guidelines suggest upto 16 wks size however difficult to practice
• 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
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
Increases Hb Level Decreases Blood Loss During Surgery Converts Hysterectomy