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Updated: Sep 12 2021

Leiomyoma (Fibroids)

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  • Snapshot
    • 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.
  • Overview
  • Introduction
    • 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
  • Presentation
    • 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
        • pain
        • constipation
        • urinary frequency
    • Physical exam
      • uterus is
        • enlarged
        • firm
        • asymmetric
        • nontender
        • multiple tumors
  • Evaluation
    • 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
  • Treatment
    • 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
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