2003-11-3 1
Myoma of Uterus
Xu Hong
2003-11-3 2
Synonyms
leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas
2003-11-3 3
Incidence
Most common solid pelvic tumors
Develop in 20～ 25% of women during
reproductive years
30～ 50 years old
2003-11-3 4
Correlative Factors
An estrogenic milieu may be necessary
Progesterone function
Growth factor and their receptor,
epithelial growth factor（ EGF）
Insulin-like growth factor（ IGF）
platelet-derived growth factor
puberty
青春期
menopause
绝经期
estrogen
雌激素
progesterone
孕激素
2003-11-3 5
Pathology
2003-11-3 6
Gross Appearance
Rare only a single,usually many exist
Well-circumscribed,nonencapsulated
A pseudocapsule is present,
The consistency is usually firm or even hard
except when degeneration or hemorrhage has
occurred,
color,light gray or pinkish white
cut section,an intertwining pattern or
a whorl-like arrangement；
bulgy
pseudocapsule
假包膜
2003-11-3 7
Smooth muscle tumors of the uterus are often
multiple,Seen here are submucosal,intramural,
and subserosal leiomyomata of the uterus,
2003-11-3 8
Microscopic Appearance
Composition,smooth muscle
connective tissue
The nonstriated muscle fibers are arranged
in bundles of various sizes that run in
multiple directions,
2003-11-3 9
Classification（ 1）
According to growth location,
? Myomas on the body of uterus（ 90%）
? Myomas on the cervix of uterus（ 10%）
2003-11-3 10
Classification（ 2）
According to the relation to uterine muscle,
? Submucous（ 10 ～ 15%）
? Intramural（ 60 ～ 70%）
? Subserosal（ 20%）
Few leiomyomas are actually of a single ―pure‖ type,
— hybrids
2003-11-3 11
Clinical Manifestation
2003-11-3 12
Symptoms
menorrhagia and prolonged menstrual period,
common
Pelvic pain,
occurs in pregnancy if undergoing degeneration
or torsion of a pedunculated myoma
Pelvic pressure,urinary frequency
bowel difficulty（ constipation）
Spontaneous abortion
Infertility
menorrhagia
月经过多
pedunculated
有蒂的
spontaneous abortion
自然流产
infertility
不育症
2003-11-3 13
Signs
A palpable abdominal tumour
Pelvic examination,
uterus — enlarged and irregular；
hard
2003-11-3 14
Degeneration
Hyaline degeneration
Cystic degeneration
Red degeneration
Sarcomatous change
The others,fat degeneration
calcification
the secondary infection
Result from the diminished
vascularity of the
connective-tissue element
2003-11-3 15
Red Degeneration
Occasionally seen as a complication of pregnancy
（ during pregnancy or immediate postpartum period）
The pathogenesis is unknown,may be the result
of the accumulation of blood in the tumour
because of venous obstruction,
The cut surface resembles raw meat,
Clinical features,a cause of pain（ acute）
fever
rapid growth,tender
产褥期
2003-11-3 16
Here is a very large
leiomyoma of the uterus
that has undergone
degenerative change and is
red (so-called "red
degeneration"),Such an
appearance might make
you think that it could be
malignant,Remember that
malignant tumors do not
generally arise from benign
tumors,
2003-11-3 17
Sarcomatous Change
Rare,0.4%～ 0.8%
More common at 40～ 50 years old
Usually occur in intramural fiboids
grow quickly
vaginal bleeding
2003-11-3 18
Diagnosis
History
Bimanual examination
Ultrasonography
（ B–ultrasound examination）
Hysteroscopy
Laparoscopy
Hysterography
hysteroscopy
子宫镜检查
laparoscopy
腹腔镜检查
2003-11-3 19
Differential Diagnosis
Pregnancy
Ovarian tumour
Adenomyosis
Malignant tumors of uterus
? sarcoma of uterus
? endometrial carcinoma
? cervical cancer
2003-11-3 20
Treatment
2003-11-3 21
Observation and Follow Up
Small,asymptomatic fibroids need not be
treated,especially near menopause,
Interval,3～ 6 months
2003-11-3 22
Medical Treatment
Androgenic agents,testosterone propionate
GnRH-a,
? induce a hypoestrogenic pseudomenopausal
state
? not recommended for longer than 6 months
? ―add-back‖ regimens
丙睾
反向添加疗法，垫背疗法
2003-11-3 23
Surgery Treatment（ 1）
Indications,
greater than 10 weeks’ gestational size
menorrhagia,lead to anemia
have pressure symptoms
grows rapidly
failure of medical treatment
2003-11-3 24
Surgery Treatment（ 2）
Method,
Myomectomy—conservative therapy
preserve fertility
significant risk of recurrence
Hysterectomy— radical therapy
Subtotal hysterectomy
hysterectomy
子宫切除术
myomectomy
肌瘤剔除术
Only true ―cure‖
for leiomyomas
次全子宫切除术
2003-11-3 25
Surgery Treatment（ 3）
Approach,
? trans-abdominal
? trans-vaginal
? laparoscopic or hysteroscopic
2003-11-3 26
It is important to
individualize
the choice of
therapy,
2003-11-3 27
Uterine Leiomyomas
Complicating Pregnancy
impact on pregnancy,abortion
impact on delivery,premature labour
fetal malpresentation
retained placenta
placenta previa
need for operative delivery
（ birth canal obstruction）
postpartum hemorrhage
Conservative treatment
2003-11-3 28
Critical Points
May be related to superabundant estrogen,
Well-circumscribed,nonencapsulated,
Have a pseudocapsule,
Can be classified into submucosal,intramural
and subserosal types,
Different types have different features,
Menorrhagia is common,
Four degeneration types
Individualized treatment,include observation、
medical treatment and surgical treatment,
Myoma of Uterus
Xu Hong
2003-11-3 2
Synonyms
leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas
2003-11-3 3
Incidence
Most common solid pelvic tumors
Develop in 20～ 25% of women during
reproductive years
30～ 50 years old
2003-11-3 4
Correlative Factors
An estrogenic milieu may be necessary
Progesterone function
Growth factor and their receptor,
epithelial growth factor（ EGF）
Insulin-like growth factor（ IGF）
platelet-derived growth factor
puberty
青春期
menopause
绝经期
estrogen
雌激素
progesterone
孕激素
2003-11-3 5
Pathology
2003-11-3 6
Gross Appearance
Rare only a single,usually many exist
Well-circumscribed,nonencapsulated
A pseudocapsule is present,
The consistency is usually firm or even hard
except when degeneration or hemorrhage has
occurred,
color,light gray or pinkish white
cut section,an intertwining pattern or
a whorl-like arrangement；
bulgy
pseudocapsule
假包膜
2003-11-3 7
Smooth muscle tumors of the uterus are often
multiple,Seen here are submucosal,intramural,
and subserosal leiomyomata of the uterus,
2003-11-3 8
Microscopic Appearance
Composition,smooth muscle
connective tissue
The nonstriated muscle fibers are arranged
in bundles of various sizes that run in
multiple directions,
2003-11-3 9
Classification（ 1）
According to growth location,
? Myomas on the body of uterus（ 90%）
? Myomas on the cervix of uterus（ 10%）
2003-11-3 10
Classification（ 2）
According to the relation to uterine muscle,
? Submucous（ 10 ～ 15%）
? Intramural（ 60 ～ 70%）
? Subserosal（ 20%）
Few leiomyomas are actually of a single ―pure‖ type,
— hybrids
2003-11-3 11
Clinical Manifestation
2003-11-3 12
Symptoms
menorrhagia and prolonged menstrual period,
common
Pelvic pain,
occurs in pregnancy if undergoing degeneration
or torsion of a pedunculated myoma
Pelvic pressure,urinary frequency
bowel difficulty（ constipation）
Spontaneous abortion
Infertility
menorrhagia
月经过多
pedunculated
有蒂的
spontaneous abortion
自然流产
infertility
不育症
2003-11-3 13
Signs
A palpable abdominal tumour
Pelvic examination,
uterus — enlarged and irregular；
hard
2003-11-3 14
Degeneration
Hyaline degeneration
Cystic degeneration
Red degeneration
Sarcomatous change
The others,fat degeneration
calcification
the secondary infection
Result from the diminished
vascularity of the
connective-tissue element
2003-11-3 15
Red Degeneration
Occasionally seen as a complication of pregnancy
（ during pregnancy or immediate postpartum period）
The pathogenesis is unknown,may be the result
of the accumulation of blood in the tumour
because of venous obstruction,
The cut surface resembles raw meat,
Clinical features,a cause of pain（ acute）
fever
rapid growth,tender
产褥期
2003-11-3 16
Here is a very large
leiomyoma of the uterus
that has undergone
degenerative change and is
red (so-called "red
degeneration"),Such an
appearance might make
you think that it could be
malignant,Remember that
malignant tumors do not
generally arise from benign
tumors,
2003-11-3 17
Sarcomatous Change
Rare,0.4%～ 0.8%
More common at 40～ 50 years old
Usually occur in intramural fiboids
grow quickly
vaginal bleeding
2003-11-3 18
Diagnosis
History
Bimanual examination
Ultrasonography
（ B–ultrasound examination）
Hysteroscopy
Laparoscopy
Hysterography
hysteroscopy
子宫镜检查
laparoscopy
腹腔镜检查
2003-11-3 19
Differential Diagnosis
Pregnancy
Ovarian tumour
Adenomyosis
Malignant tumors of uterus
? sarcoma of uterus
? endometrial carcinoma
? cervical cancer
2003-11-3 20
Treatment
2003-11-3 21
Observation and Follow Up
Small,asymptomatic fibroids need not be
treated,especially near menopause,
Interval,3～ 6 months
2003-11-3 22
Medical Treatment
Androgenic agents,testosterone propionate
GnRH-a,
? induce a hypoestrogenic pseudomenopausal
state
? not recommended for longer than 6 months
? ―add-back‖ regimens
丙睾
反向添加疗法，垫背疗法
2003-11-3 23
Surgery Treatment（ 1）
Indications,
greater than 10 weeks’ gestational size
menorrhagia,lead to anemia
have pressure symptoms
grows rapidly
failure of medical treatment
2003-11-3 24
Surgery Treatment（ 2）
Method,
Myomectomy—conservative therapy
preserve fertility
significant risk of recurrence
Hysterectomy— radical therapy
Subtotal hysterectomy
hysterectomy
子宫切除术
myomectomy
肌瘤剔除术
Only true ―cure‖
for leiomyomas
次全子宫切除术
2003-11-3 25
Surgery Treatment（ 3）
Approach,
? trans-abdominal
? trans-vaginal
? laparoscopic or hysteroscopic
2003-11-3 26
It is important to
individualize
the choice of
therapy,
2003-11-3 27
Uterine Leiomyomas
Complicating Pregnancy
impact on pregnancy,abortion
impact on delivery,premature labour
fetal malpresentation
retained placenta
placenta previa
need for operative delivery
（ birth canal obstruction）
postpartum hemorrhage
Conservative treatment
2003-11-3 28
Critical Points
May be related to superabundant estrogen,
Well-circumscribed,nonencapsulated,
Have a pseudocapsule,
Can be classified into submucosal,intramural
and subserosal types,
Different types have different features,
Menorrhagia is common,
Four degeneration types
Individualized treatment,include observation、
medical treatment and surgical treatment,
