Benign tumors of Uterus

Benign Tumours of the Uterus
Uterine Fibriods

Prof. Bilqis Afridi

Uterine Fibriods
nAlso called Leiomyoma , fibromyoma

Commonest tumour found in the uterus and genital tract
nabout 20 % of all females.
Aetiology unknown
Predisposing Factors


Hormonal imbalance Anovulation, regress after Menopause

Low Parity such as Nulliparous

Racial factors Negroes

Association with endometriosis

Association with Ca body of uterus
Both factor 4 and 5 are also common in patient of low parity.



INTRODUCTION
Pathology
Macroscopically
nCharacteristically firm, rounded encapsulated tumour (false capsule)
nTypes
–Intramural
–Subserous
–Intra Ligamentary
–Sub Mucous
–Parasitic
–Cervical
Sometimes from round Ligament
Pathology (Conti..)
Size
nVariable small to very large

Number
nSingle , Multiple
Consistancy
nTypically fiberoids have firm consistancy and smooth surface

Microscopically
Mainly composed of muscle cells arranged in bundles in a classically whorled pattern
Blood Supply
Enters from periphery and centers relatively avascular so degenerative changes are common

Degenerative Changes in fiberoids
Hyaline degeneretion
Cystic degeneration
Calcification
Red degeneration
They occur usually during pregnancy when there is sudden change in the size of feroids.

Microscopically (conti..)

nSarcomatous changes
are not common
nInfection
in fiberoids occur secondary to infection in other adjacent organs in the pelvis and peritoneal cavity
Clinical Features
Symptomless: Small fiberoids are usually symtopmless
Abdominal swelling
Menstural irregularities
Menorrhagia
intermenstrual bleeding
postcoital bleeding
Infertility
Pressure effect
Oedema Leg
o Vericose veins
o Frequency of micturation
o Dyspnoea
o Stress incontinence
o Heamorroids

o Pain
o Congestive Dysmenorrhoea
o Backache
o Torsion of pedunculated fibroids
o Red degeneration
o Sarcomatous changes
o Infection
o Abortions are common with fibroids
DIFFERENTIALS:
Ø Adenomyosis:
Ø Ovarian tumor
Ø Other conditions like
Ø PREGNANT UTERUS
Ø FULL BLADER
Ø TUBO OVARIAN MASS
Ø BRAOD LIGAMENT CYST
Ø ENDOMETRIOTIC CYST
Ø MESENTARIC CYST
Diagnosis of Fibroids
Physical signs
Depends on size, No, type, Situation, presence of degenerative changes.

Abdominal examination

Vaginal examination

Investigations

Diagnosis of Fibroids
nEXAMINATION:
nUS
nHYSTEROSCOPY
nMRI
nCT
nXRAY
nENDOMETRIAL BIOPSY
nHYSTEROSALPINGOGRAPHY
U/S
HYSTEROSCOPE
nMRI scans
TREATMENT
nCONSERVATIVE small size with no symptoms near Menopause.
DIAGNOSTIC CURRETAGE : if there is Dysfunctional uterine Bleeding
nSurgical treatment
–If symptoms presents
–Size – large then 14 wks pregnancy
–Diagnosis in doubt
nTreatment with medicines:

1) GnRH agonists
2) NSAIDS
3) Oral contraceptive pills
4) Anti Estrogens
5) General measures
Surgical Treatment of Fibroids
nSubmucous Myomas


1. hysteroscopic resection
2. endometrial ablation
nIntracavitary Myomas


1. hysteroscopic resection of myomas

nIntramural and Pedunculated Myomas

three types of procedures
1. remove the fibroid(s
2. destroy the fibroid(s
3. remove the uterus
nEndometrial-Ablation

nroller ball
nA wire loop
nThermal Choice Balloon Ablation
Surgical Treatment
nTwo main operations
1. Myomectomy
2. Hystrectomy
Usually Abdominal
Rarely Vaginal
n Management Depends upon
Age and Parity
Size and Number of fibroids
Site of the tumour


nHystrectomy is a better procedure because
Fibroids will not recur
Symptoms relieved with certainity
Operation is generally easier
Blood loss is less
Less post operation morbidity



nHystrectomy is indicated when

· Patient has completed her family

· Age of patients is more

· Fibroids are multiple and there is no possible hope of pregnancy.

Surgical Treatment of Fibroids
nIntramural and Pedunculated Myomas

Destruction of the fibroid(s):

myolysis
laser
electrical device
cryomyolysis

Uterine artery embolization:

Myomectomy
Is indicated when patient is young and of low Parity
Risks of Mymectomy
Recurrence a possibility
Infertility and Abortion may still exist
Delivery by C/S if uterine cavity is opened during myomectomy
Repeat myomectomy may be required
Hystrectomy may be required soon or later


Rupture of Myomectomy scar
Risk of postoperative Complication are more i.e pyrexia , more pain, adhesions.
Long term complications
Chronic pain
Infertility
Fibroids during pregnancy
v Enlarges becomes soft and flatten out

v Red degeneration more common

v Abortions are common if implanted over submucous fibroids

v Obstructed labour if situated in Cervix or lower segment



v Post Partum Haemorrhage

v Torsion of pedunculated fiborid more common after delivery.
v Infection
Uterine Sarcoma
1 – 3% of all genital tract malignancy
Commonly 3 types
Ø Leomyosarcoma – 40 %
Ø Mixed mullarian tumour – 40 %
Ø Endometrial stromal sarcoma – 15%
Ø Rare Varities - 5 %
Clinical Features
nAge – mean age 60 years
nAbnormal vaginal bleeding
nAbdominal pain
nAbdominal destension
nDysurea, weight loss, bowel related symptoms, infertility

Signs
Enlarged uterus, extra uterine extention
Lymphodenopathy, hepatomegaly

Spread
Via Lymphatic
Via blood Vessels
Sarcoma is high malignant tumour
Treatment
nSurgery TAH and BSO

nRadio therapy

nChemo therapy