Updated: 10/12/2018

Leiomyoma (Fibroids)

Review Topic
  • A 30-year-old African American G0P0 with no significant past medical history presents with chronic pelvic pain. She denies any other symptoms. Physical exam reveals a mobile uterus that is nontender with multiple discrete nodules. A transvaginal ultrasound shows hyperechoic masses within the uteruine myometrium. She decides to undergo a myomectomy that will preserve her ability to bear children.
  • Otherwise known as fibroids
  • Leiomyomas are smooth muscle growths of the uterine myometrium
  • Epidemiology (most common)
    • benign uterine tumor
    • tumor in females
    • seen in African Americans (5x more common)
    • occurs in women 20-40 years of age
  • Often present with multiple discrete tumors
  • Symptoms
    • sensitive to estrogen levels
      • tumor growth and increased symptoms during pregnancy
      • decreased symptoms during menopause
    • may present with
      • no symptoms
      • abnormal uterine bleeding
        • iron deficiency anemia
      • miscarriage
  • Physical exam
    • uterus is
      • enlarged
      • firm
      • asymmetric
      • nontender
      • multiple tumors
  • Diagnose with clinical history and exam
  • Confirm with sonogram
    • transvaginal ultrasound has high sensitivity (95-100%)
    • hyperechoic, well-circumscribed round masses
  • Labs
    • β-hCG to rule out pregnancy
  • Histology 
    • whorled pattern of smooth muscle bundles
Differential Diagnosis
  • Leiomyosarcoma 
  • Adenomyosis
  • Endometrial polyp
  • Pregnancy
  • If asymptomatic
    • observation
      • fibroids can shrink substantially postpartum and after menopause
  • If symptomatic
    • premenopausal
      • OCPs
      • NSAIDs
      • myomectomy
    • postmenopausal
      • myomectomy
      • hysterectomy
Prognosis, Prevention, and Complications
  • Prognosis
    • having symptomatic fibroids decreases quality of life
  • Complications
    • very rarely (if at all) transforms into leiomyosarcoma
    • infertility

Please rate topic.

Average 4.7 of 3 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (7)
Private Note