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Leiomyoma (Fibroids)

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Topic updated on 02/05/17 8:47pm

Snapshot
  • A 30-year-old African American G0P0 with no significant past medical history presents with chronic pelvic pain. She denies any other symptoms. Physical exam reveals a mobile uterus that is nontender with multiple discrete nodules. A transvaginal ultrasound shows hyperechoic masses within the uteruine myometrium. She decides to undergo a myomectomy that will preserve her ability to bear children.
Introduction
  • Otherwise known as fibroids
  • Leiomyomas are smooth muscle growths of the uterine myometrium
  • Epidemiology (most common)
    • benign uterine tumor
    • tumor in females
    • seen in African Americans (5x more common)
    • occurs in women 20-40 years of age
  • Often present with multiple discrete tumors
Presentation
  • Symptoms
    • sensitive to estrogen levels
      • tumor growth and increased symptoms during pregnancy
      • decreased symptoms during menopause
    • may present with
      • no symptoms
      • abnormal uterine bleeding
        • iron deficiency anemia
      • miscarriage
  • Physical exam
    • uterus is
      • enlarged
      • firm
      • asymmetric
      • nontender
      • multiple tumors
Evaluation
  • Diagnose with clinical history and exam
  • Confirm with sonogram
    • transvaginal ultrasound has high sensitivity (95-100%)
    • hyperechoic, well-circumscribed round masses
  • Labs
    • β-hCG to rule out pregnancy
  • Histology 
    • whorled pattern of smooth muscle bundles
Differential Diagnosis
  • Leiomyosarcoma 
  • Adenomyosis
  • Endometrial polyp
  • Pregnancy
Treatment
  • If asymptomatic
    • observation
      • fibroids can shrink substantially postpartum and after menopause
  • If symptomatic
    • premenopausal
      • OCPs
      • NSAIDs
      • myomectomy
    • postmenopausal
      • myomectomy
      • hysterectomy
Prognosis, Prevention, and Complications
  • Prognosis
    • having symptomatic fibroids decreases quality of life
  • Complications
    • very rarely (if at all) transforms into leiomyosarcoma
    • infertility


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