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Fibroids
Uterine fibroids ("fibroids", leiomyomata, singular leiomyoma) are the most common neoplasm in females, and may affect about of 25 % of white and 50% of black women during the reproductive years. They are a major indication for a hysterectomy.
Uterine fibroids ("fibroids", leiomyomata, singular leiomyoma) are the most common neoplasm in females, and may affect about of 25 % of white and 50% of black women during the reproductive years. They are a major indication for a hysterectomy.
symptoms of fibroid tumors
Fibroids, particularly when small, may be entirely asymptomatic. Generally, fibroid symptoms relate to the location of the lesion and its size. Important symptoms include abnormal gynecologic hemorrhage, pain, infertility, dysuria and urinary frequency. During pregnancy they may be the cause of miscarriage, bleeding, premature labor, or interference with the position of the fetus.
pathology and histology
Leiomyomas grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white, or tan whorled. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall. Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whirled). These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and mitotically active.
estrogen and fibroids
Leiomyomas are estrogen sensitive and have estrogen receptors. They may enlarge rapidly during pregnancy presumably due to increased estrogen levels. As estrogen levels decline with menopause, fibroids tend to regress after menopause. Hormonal therapy takes advantage of the fact that lack of estrogens leads to shrinkage of fibroids.
location
Fibroids may be single or multiple. Most fibroids start in an intramural location,- that is the layer of the muscle of the uterus. With further growth, some lesion may develop towards the outside of the uterus (subserosal or pedunculated), some towards the cavity (submucosal or intracavitary). Lesions affecting the cavity tend to bleed more and interfere with pregnancy. Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and cystic changes. Less frequently, leiomyomas may occur at the lower uterine segment, cervix, or uterine ligaments.
diagnosis of fibroids
Diagnosis is usually accomplished by bimanual examination, better yet by gynecologic ultrasonography. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam. In cases where a more precise assay of the fibroid burden of the uterus is needed, also magnetic resonance imaging (MRI) can be used to generate a depiction of the size and location of the fibroids within the uterus. While no imaging modality can clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma, the rarity of the latter and the prevalence of the former make it, for practical purposes, a non-issue unless evidence of local invasion is present. For this reason, biopsy is rarely performed.
Posted by Staff at May 21, 2005 1:01 AM
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