INTRODUCTION

 FIBROIDS ARISE FROM THE

MYOMETRIUM AND CONSIST OF
VARYING PROPORTION OF SMOOTH
MUSCLE AND FIBROBLASTS.

 50% are asymptomatic.

AETIOLOGY

 Ovarian steroids (especially estrogen) regulate

the growth of fibroids.
 Bcl-2 , an inhibitor of apoptosis, is significantly

in leiomyoma cells and is also influenced by the

steroid hormones.
 Cytogenic abnormalities – translocation / del of
chr.7 , translocation of chr.12 & 14 and structural
aberration of chr.6
 MAJOR RISK FACTORS
1. Ethnicity (More in Africans and Caribeans)
2. Early age of menarche
3. Nulliparity
4. Increasing body weight
5. Familial association
6. Exogenous hormones
7. Smoking reduces the risk
TYPES OF FIBROID
FIGO LEIOMYOMA CLASSIFICATION
0 Submucous ; completely intracavitary
1 Submucous ; <50% intramural
2 Submucous ; >50% intamural
3 Intramural , but just contacts endometrium
4 Intramural
5 Subserous > 50% intramural
6 Subserous < 50% intramural
7 Subserous pedunculated
8 Others with no myometrial involvement(cervical
, broad lig)
PATHOLOGY

 Single ; more commonly multiple.

 Consistency – Firm ad Fibrous
 Cut surface is smooth and shows a white
whorled appearance and trabeculation due
to the presence of fibrous tissue and muscle
bundles.
 Blood supply – Vessels through
pseudocapsule
 Periphery –more vascular
 Central part – likely to undergo degeneration
 Microscopy : Smooth muscle fibres and and
fibrous tissue
DEGENERATIONS
1. Hyaline degeneration
2. Cystic degeneration
3. Calcification or calcareous degeneration
4. Red degeneration or carneous degeneration
OTHER COMPLICATIONS
1) Sarcomatous changes
2) Leiomyomatosis
3) Wandering Fibroids
4) Infection
5) Torsion of pedunculated Fibroid
6) Pseudo meig syndrome
7) Polycythemia
CLINICAL FEATURES
 SYMPTOMS (Depends upon the site & not
size)
Submucous fibroid – Menorrhagia
Whereas
Subserous fibroid may be asymotomatic
 Also low back pain (posterior fibroids )

{ Peak incidence b/w 35 & 45 ; Mostly

nullipara and infertility}
 Urinary symptoms

-Urinary frequency
-Difficulty in initiating the act of micturition
- Incomplete emptying of bladder
-Large fibroids can lead to Ureteric compression
& later on hydronephrosis

 Oedema of the lower limbs

 Abdominal distension
 Infertility
 Recurrent miscarriage
SIGNS

 Abd examination – reveals a pelvic mass with

smooth and irregular surface , firm consistency
 Lower border may not be palpable (except
pedunculated fibroids)
 Bimanual examn – to diff. ovarian tumour and
fibroid
 Fibroid – uterus will not be felt seperately

Also there will be transmitted mobility

DIFFERENTIAL DIAGNOSIS
1. PREGNANCY
2. FULL BLADDER
3. ADENOMYOSIS
4. PYOMETRA
5. ENDOMETRIAL CANCER AND SARCOMA
6. SOLID OVARIAN TUMOURS
7. PELVIC INFECTION & TUBOOVARIAN
MASS
INVESTIGATIONS

 ULTRASOUND – (TVS/TAS ) The appearance

is usually hypoechoic. It is essential to confirm
the nature of pelvic mass. R/A adenomyosis and
hydronephrosis.
 SONOHYSTEROGRAPHY – Useful in
identifying small submucous fibroids.
 HYSTERSCOPY

 HAEMATOLOGICAL INVESTIGATIONS –
Hb and PCV
MANAGEMENT
1. Expectant
2. Medical
3. Surgical
4. Uterine Artery Embolization
 MEDICAL MANAGEMENT
 GnRH Agonists
goserilin 3.6mg or leuprolide 3.75mg as
monthly s/c depot injection
They are best used preoperatively & just
before the menopause.
Optimal duration prior to surgery is 3mo.
 Antiprogestins – Mifepristone 25-50mg daily

 GnRH Antagonists – Cetrorelix & ganirelix

 INTRAUTERINE DEVICE (Mirena)

SURGICAL MANAGEMENT
i. Hysterectomy OPEN
ii. Myomectomy

HYSTEROSCOPIC

LAPROSCOPIC