leiomyomas
LEIOMYOMAS

Leiomyomas or uterine fibroids are benign tumors of the uterus that consist of smooth muscle and extracellular matrix collagen and elastin.

Most common solid pelvic tumors and one of the most frequent clinical conditions encountered in gynecologic practice.

They tend to grow during the reproductive years and usually regress during menopause.

 

Classification

  • Based on location, fibroids can be:
    • Submucosal (protruding into the uterine cavity)
    • Intramural (found within the myometrium)
    • Subserosal (protruding outside the uterus) 
  • Fibroid classification may use the European Society for Gynecological Endoscopy (ESGE) or the International Federation of Gynecology and Obstetrics (FIGO) classification wherein the degree of uterine cavity distortion and/or intramural extension are taken into account 

Physical Examination

  • Pelvic exam may reveal a palpable enlarged, firm, and irregular uterus
    • A pelvic mass that moves with the uterus is suggestive of fibroids
  • Myomatous uterus’ size is reported in menstrual week as is a pregnant uterus
    • Size of >12 to 20 weeks may be palpated on abdominal exam
  • Diagnosis can be difficult in obese women

Laboratory Tests

  • A CBC to evaluate hemoglobin (Hb) will detect iron-deficiency anemia in patients with heavy menstrual bleeding

Imaging

  • Transvaginal ultrasound (TVS): Helpful in assessing the adnexae and growth of myoma
  • Transvaginal sonohysterography (TVSH): Should be considered if submucosal fibroids and polyps are suspected
    • TVSH may avoid the need for diagnostic hysteroscopy in approximately 47% of women who can then proceed to planned operative hysteroscopy
  • Magnetic resonance imaging (MRI): May be considered in women in whom the location and nature of the fibroids remain unclear after TVS and TVSH
    • May also be used in those who wish to avoid discomfort of TVSH
    • MRI predictors of malignancy include age >45 years, menopausal status, thickening of the endometrium, presence of intratumoral hemorrhage, nonmyometrial origin, and T2-weighted signal heterogeneity 
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