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.

 

Leiomyomas Diagnosis

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 
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
06 Jul 2020
Routinely used for treating cardiovascular diseases, statins have been shown to benefit other conditions, and new evidence suggests that using the drug at high intensity reduces the risk of hip or knee replacement, an effect that may be specific to rheumatoid arthritis.
Jairia Dela Cruz, 06 Jul 2020
Following vegan and vegetarian diets, which offer plenty of what is good for health, has been reported to have a downside: an increased risk of depression and anxiety, especially for younger adults.
Pearl Toh, 29 Jun 2020
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
Roshini Claire Anthony, 5 days ago

Upadacitinib may be a suitable treatment for patients with active psoriatic arthritis (PsA) who have insufficient response to non-biologic disease-modifying anti-rheumatic drugs (non-bDMARDs), according to results of the phase III SELECT-PsA-1* trial presented at EULAR 2020.