子宫肌瘤
Leiomyomas of uterus
复旦大学妇产科医院
徐丛剑
Leiomyomas of uterus
? Commonest tumors 25% of women,20% of female >
30y do have fibroid.
? Also called as,Fibroids”
? Estrogen responsive,regress after castration or menopause.
? Often rapid increase during pregnancy or during oral
contraceptive use,and regress after menopause
? Whorls of smooth muscle,well demarcated
? Asymptomatic,bleeding or Press on bladder
? Abortion,malpresentation etc.
Causes
? Unknown.
? Hyperestrogenemia？
High response to estrogen?
? Heredity
Uterine leiomyoma
Corporeal
?90%
?multiple
Cervical
?10%
?solitary
Uterine leiomyoma
submucus
?15%
?not capsulated
Subserous
?20%
Interstitial
?65%
Submucous myoma
http://www.obgyn.net
Leiomyomata Uterus
CUT SECTION
? Well demarcated surrounding muscle.
? whorly (intermingling muscle fibers and
fibrous tissue).
? Paler than surrounding (Ischaemia).
Degeneration
? Leiomyomas enlarge outgrow
their blood supply various
types of degeneration
– Hyaline degeneration
– Cystic degeneration
– Red degeneration - during pregnancy,secondary to
venous thrombosis within the periphery of the
tumor or rupture of intratumoral arteries
– Sarcomatous change -less than 3%
– Degeneration with calcification
SYMPTOMS
? Bleeding
menorrhagia
metrorrhagia
? Pain
congested
Dysmenorrhea
degeneration
infection
torsion
? Infertility,Abortion
? mass.
? Discharge.
? Pressure symptoms.
Signs
?Symmetrically enlarged
uterus(submucosal
fibroid).
?Asymmetrically enlarged
uterus(subserous fibroid)
DIFFERENTIAL Diagnosis
? ADEMOMYOSIS
– - presence of ectopic endometrial glands and stroma
withinthe myometrium,which are associated with
reactive hypertrophy of the surrounding myometrial
smooth muscle
– - most commonly a diffuse abnormality but may also
occur as a focal mass,which is known as an
adenomyoma
– - diffuse form of adenomyosis appears as a thickened
junctional zone (inner myometrium) on T2-weighted
images
Uterus Adenomyosis:
Differential Diagnosis
? Uterine Leiomyosarcoma
– - may arise in a previously existing benign
leiomyoma (sarcomatous transformation) or
independently from the smooth muscle cells of the
myometrium
– - Although it has been suggested that an irregular
margin of a uterine leiomyoma at MR imaging is
suggestive of sarcomatous transformation,the
specificity of this finding has not been established
– - A diagnosis of leiomyosarcoma is established
histologically by noting the presence of infiltrative
margins,nuclear atypia,and increased mitotic
figures
Leiomyosarcoma:
Treatment of Leiomyoma
? No treatment
? Conservative
? Surgical
? Myolysis.
? Uterine A
embolization.
?Patient (age-parity-
symptoms).
?Fibroid (number-size-
type)
?Complications.
SURGICAL
? Myomectomy
? Hysterectomy.
?Traditional
?microsurgical
Medical
? Androgen:
? GnRHa
? Mifepristone
? TCM
Pregnancy woman with
leiomyomas of uterus
? In patients with leiomyomas of uterus,
0.5%~1%
? In Pregnancy woman,0.3%~0.5%
? Red degeneration
? Abortion
谢 谢！
Leiomyomas of uterus
复旦大学妇产科医院
徐丛剑
Leiomyomas of uterus
? Commonest tumors 25% of women,20% of female >
30y do have fibroid.
? Also called as,Fibroids”
? Estrogen responsive,regress after castration or menopause.
? Often rapid increase during pregnancy or during oral
contraceptive use,and regress after menopause
? Whorls of smooth muscle,well demarcated
? Asymptomatic,bleeding or Press on bladder
? Abortion,malpresentation etc.
Causes
? Unknown.
? Hyperestrogenemia？
High response to estrogen?
? Heredity
Uterine leiomyoma
Corporeal
?90%
?multiple
Cervical
?10%
?solitary
Uterine leiomyoma
submucus
?15%
?not capsulated
Subserous
?20%
Interstitial
?65%
Submucous myoma
http://www.obgyn.net
Leiomyomata Uterus
CUT SECTION
? Well demarcated surrounding muscle.
? whorly (intermingling muscle fibers and
fibrous tissue).
? Paler than surrounding (Ischaemia).
Degeneration
? Leiomyomas enlarge outgrow
their blood supply various
types of degeneration
– Hyaline degeneration
– Cystic degeneration
– Red degeneration - during pregnancy,secondary to
venous thrombosis within the periphery of the
tumor or rupture of intratumoral arteries
– Sarcomatous change -less than 3%
– Degeneration with calcification
SYMPTOMS
? Bleeding
menorrhagia
metrorrhagia
? Pain
congested
Dysmenorrhea
degeneration
infection
torsion
? Infertility,Abortion
? mass.
? Discharge.
? Pressure symptoms.
Signs
?Symmetrically enlarged
uterus(submucosal
fibroid).
?Asymmetrically enlarged
uterus(subserous fibroid)
DIFFERENTIAL Diagnosis
? ADEMOMYOSIS
– - presence of ectopic endometrial glands and stroma
withinthe myometrium,which are associated with
reactive hypertrophy of the surrounding myometrial
smooth muscle
– - most commonly a diffuse abnormality but may also
occur as a focal mass,which is known as an
adenomyoma
– - diffuse form of adenomyosis appears as a thickened
junctional zone (inner myometrium) on T2-weighted
images
Uterus Adenomyosis:
Differential Diagnosis
? Uterine Leiomyosarcoma
– - may arise in a previously existing benign
leiomyoma (sarcomatous transformation) or
independently from the smooth muscle cells of the
myometrium
– - Although it has been suggested that an irregular
margin of a uterine leiomyoma at MR imaging is
suggestive of sarcomatous transformation,the
specificity of this finding has not been established
– - A diagnosis of leiomyosarcoma is established
histologically by noting the presence of infiltrative
margins,nuclear atypia,and increased mitotic
figures
Leiomyosarcoma:
Treatment of Leiomyoma
? No treatment
? Conservative
? Surgical
? Myolysis.
? Uterine A
embolization.
?Patient (age-parity-
symptoms).
?Fibroid (number-size-
type)
?Complications.
SURGICAL
? Myomectomy
? Hysterectomy.
?Traditional
?microsurgical
Medical
? Androgen:
? GnRHa
? Mifepristone
? TCM
Pregnancy woman with
leiomyomas of uterus
? In patients with leiomyomas of uterus,
0.5%~1%
? In Pregnancy woman,0.3%~0.5%
? Red degeneration
? Abortion
谢 谢！
