Fibroid uterus : Fibroid uterus By Dr Ravikanth
Dept of obgy
Fibroid uterus (syn.leiomyoma,fibroma , myoma,) : Fibroid uterus (syn.leiomyoma,fibroma , myoma,) Commonest pelvic tumour-20%
Arise from progenitor myosite
Composed of muscle tissue with variable amount of connective tissue
Frequently multiple may be 200 in one uterus
Slow to grow
Etiology : Etiology Exact etiology is not known
Rare before 20 yrs
20% in over 20 yr age
40%in over 40 yrs age
Common in nulliparus and infertile woman
‘Fibroids are the reward of virtue,babies the fruit of sin’
Familial incidence
Functional cysts of ovary
Ass,-endometrial ca,endometriosis,
Sites of fibroid : Sites of fibroid
Rare variety : Rare variety
Rare variety : Rare variety Parasitic fibroid
wombstone
symptom : symptom Asymptomatic
Menorrhage
Metrorhagia
Pain abdomen
Mass per abdomen
General effects on the body : General effects on the body Effects of anaemia
Polycythemia –large broad ligament type
Hypoglycaemia –in retroperitoneal
Dyspepsia
Urinary symptoms –frequency,retention
Infertility ‘Woman postpones her pregnacy later fibroid postpones it ’ site of fibroid & ass,condition
Pregnancy complications
Secondary changes : Secondary changes Degenaration
atrophy
fatty change
calcification
cystic degenaration
red degenaration
Torsion
Infection
Sarcomatous change – 0.2% Plain x-ray
Diagnosis : Diagnosis degen haemor fib tvs Contrast enhanced CT
Slide 12: Thick endo Endo polyp sonosalphingography tvs
Slide 13: egg shell calcification tvs
Slide 14: T2 sagital T1 axial T1 sagital MRI
Slide 15: Hysteroscoppic view normal Submucosal polyp
Differential diagnosis : Differential diagnosis Adenomyosis
Pregnancy
Ovarian tumour
Abdominal tumour –eg.enterogenous cyst
Abdominal tuberculosis
Management : Management No treatment
<12 wk
asymptomatic
perimenopausal
General treatment
correction of anaemia
Palliative treatment
Waiting for surgery - danazol,progestogens,GNRHagonests.
Management : Management D&C,or endometrial aspiration
Polypectomy
Hysteroscopic
Myomectomy
Only as a Rx of infertility
Hysterectomy
vagainal , abdominal,laproscopic,LAVH
Embolisation
Slide 32: Wt 600g
Slide 33: 2nd postoperative day
Slide 34: After one month
Slide 35: After three month
Slide 36: Another case 26 wk fibroid Wt -1kg