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Uterine leiomyoma

Definition
  • Benign, smooth muscle tumors of the uterus
  • Location:
    • intramural - 70%
    • subserous - 10%
    • submucosal - 10%
Risk Factors

Differential diagnosis
    • ovarian tumours:
      • ovarian cysts - cystic, rarely cause menstrual disturbance, and grow more rapidly
      • ovarian fibroma - often with ascites as Meig's syndrome
      • ovarian carcinoma - usually irregular
    • tubo-ovarian inflammatory mass - uterus not enlarged, mass tender, blood tests usually show leucocytosis, raised ESR
    • pregnancy - associated amenorrhoea, uterus soft, foetus detectable by ultrasound from 7th week onwards
    • uterine endometriosis - uterus only slightly enlarged, usually dysmenorrhoea
    • diverticular disease - identifiable by barium enema
    • colonic carcinoma - identifiable by sigmoidoscopy
Epidemiology
  • Three times more common in black females, and occur at an earlier age
Aetiology
  • Minimal malignant potential but may grow to enormous size
  • Oestrogen dependent
  • Affect 20% of women by age 40
  • Occur with increased frequency in conjunction with endometrial hyperplasia and granulosa cell tumours of the ovary
Clinical features 
  • Bloating
  • menorrhagia
  • urinary frequency/retention
  • infertility
  • dystocia
Pathophysiology

Investigations
  • very large fibroids may be palpated abdominally
  • vaginal examination usually reveals a firm, irregularly enlarged uterus that is non-tender; an exception is one undergoing red degeneration which may be very tender
  • most fibroids move with the cervix - except if subserous, detached and parasitic
Management

a) conservative
  • Majority are asymptomatic and do not require treatment
b) medical

c) surgical
  • Surgical intervention is indicated if:

    • there is heavy or prolonged bleeding
    • the tumour is large, even if asymptomatic; in young women, it will continue to grow; following the menopause, it may undergo complications
    • there is urinary symptoms
    • the tumour has undergone torsion
    • the tumour threatens to obstruct labour
Prognosis

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