LEIOMYOMA (biasa dsbut fibroid)

Definisi
Tumor jinak pada otot polos (dtmukan ptama oleh Virchow 1854), umumnya
memiliki kariotipe normal tp kadang terjadi ketidaknormalan kromosom.
Sitogenetik yg sudah ditemukan:
-. Translokasi kromosom 12 & 14
-. Delesi parsial lengan panjang kromosom 7
-. Trisomi 12
-. Rearrangement kromosom 6p, 3q, 10q
Indikasi bhw adany sifat herediter yg mnyebabkan multiple leiomyoma
dtmukan pd th 1958.
Patofisiologi
Ada 3 macam leiomyoma berdasarkan asal mula otot polos tersebut:
Piloleiomyoma : otot polos pada dermis retikuler, tidak berkapsul, aktifitas
mitosis rendah, lesi yg terbentuk bisa soliter / multipel
Angioleiomyoma : otot polos pembuluh darah arteri / vena (dilatasi),
berkapsul, dikelilingi oleh sel endotelial, kolagen sedikit, lesi soliter
Genital leiomyoma : otot polos organ genitalia, lesi soliter, ciri histologis
seperti piloleiomyoma
Makroskopik
Sharply circumsribed, round, firm, gray-white tumor.
Ditemukan pada myometrium corpus uteri, bisa di submukosa, subserosa atau
intramural. Tumor yg sudah bsr mnjadi yellow-brown kmudian brubah mnjadi
merah dan lunak (red degradation).
Mikroskopik
Secara histologi, otot polos dan kolagen menghasilkan warna pink-merah
dengan pewarna haematoxylin-eosin.
Dengan Masson Trichome : otot polos merah tua, kolagen hijau kebiruan
Dengan Anilin Biru : otot polos merah, kolagen biru
Bentuk dan warna sel seragam dengan oval nucleus dan panjang, slender
bipolar sitoplasma, sedikit mitosis.

Leiomyoma jinak : atypical / bizzare dengan atypia nuclear & giant cell.
Leiomyoma dengan benign metastatic (sgt jarang) : extend ke vessels & lung.
Disseminated peritoneal leiomyomatosis (sgt jarang) : nodules kcil bnyk di
rongga peritonium.
Leiomyoma mnybabkn abnormal bleeding, sakit, infertility; klo pd org hamil
mnybabkn aborsi, fetal malpresentation, uterine inertia, & postpartum
haemorrhage.
Treatment
GnRH analog : nekrosis koagulatif, apoptosis lebih dominan, infiltrasi
limfosit, pengecilan ukuran tumor dikarenakan berkurangnya cell-cycle
karena reseptor estrogen dan progesteron yg sedikit
Alfa adrenergik bloker : kurangi kontraksi otot polos
Calsium channel blocker : influx Ca menyebabkan kurangnya impuls
Artery embolization : lokal anastesi, dengan femoral artery puncture dan
kateterisasi hypogastric lalu uterine arteries

a Macroscopic appearance of the lesion mimicking an invasive tumour. b

(desmin, 40): Immunohistochemistry shows both the lesion and the
surrounding myometrium are desmin positive.

(haematoxylin-eosin, 40)a: The leiomyoma dissects into the surrounding

myometrium (black arrow) at the cornu. b: There is hydropic change around
groups of smooth muscle bundles a pattern referred to as perinodular hydropic
degeneration.

Submucosal leiomyoma. The sharp line of

demarcation between the leiomyoma and the
surrounding myometrium is clearly shown. In
this submucosal position, the overlying
endometrium is compressed and atrophic,
which often leads to a complaint of bleeding.

Leiomyoma, the smooth muscle cells are

markedly elongated, have eosinophilic
cytoplasm and cigar shaped nuclei.

Red degeneration (necrobiosis), on the other

hand, is a form of degeneration that occurs
commonly in pregnancy, and the process is
often the cause of pain and fever. The cut
surface takes on a more homogeneous look,
with loss of the whorled appearance. The
color becomes a deeper pink or red and the
consistency softer

Multiple leiomyomas. On cut section, the

tumors are well circumscribed, bulging above
the cut surface. These leiomyomas are
intramural and one is submucosal. A prolapsed,
submucosal leiomyoma protrudes into the
endocervical canal.