UterineMyoma

GeneralConsiderationFairlyhighincidenceinwomenbetweenage30

to

50year,about30%Mostlybenign,withoutsymptomcomposedofsmoothmuscleandconnectivetissuePathogenesis

femalehormones:(estrogenandprogesterone)1.Occurinreproductiveage2.Nonewformationaftermenopause3.IncreaseinsizeduringpregnancyClassificationbyanatomiclocation:1.uterinecorpusmyoma90%2.cervicalmyoma10%Classificationbyrelationbetweenmyomaandmyometrium:1.Intramuralmyoma60%～70%2.Subserous

myoma20%3.Submucous

myoma10%～15%Pathology1.Naked-eyeappearance

falsecapsule,gray-colored,rounded,smooth,hard,whorledpattern2.MicroscopicalstructuresmoothmuscleandfibroustissueDegeneration1.Hyalinedegeneration2.Cysticdegeneration3.Reddegeneration4.Malignanttransformation5.Degenerationwithcalcification

Degeneration

1.Hyalinedegenerationmostcommonhomogeneous/transparentappearance,absenceofwhorledpattern,absenceofmusclecells,structurelesseosinophilic2.Cysticdegenerationliquefactionoftheareasofhyalinechange,capsularspacecontainingclearfluidDegenerationDegeneration3.Reddegenerationspecialtypeofnecrosis

duringpregnancy,puerperium

duetovenousthrombosis

andhemolysis

withhemorrhagered-stained,soft“rawmeat”abdominalpainfeveruterusenlargedwithtenderness

4.Malignanttransformation(sarcomatouschange)rare

0.4%～0.8%DegenerationDegeneration5.Degenerationwithcalcificationsubserousmyomawithsmallpeduncle

postmenopauseClinicalFindingsSymptomsonly35%～50%symptomaticdependingonthelocation,size,numberanddegenerationofthetumorsSymptoms1.Abnormaluterinebleeding

2.Lowerabdominalmass

3.Pain

4.Pressureeffects

5.Effectsonpregnancyandchildbearing

1.Abnormaluterinebleedingmenorrhagia(prolonged,heavymenses)Where:largeintramuralmyomasubmucousmyomaWhy:EndometriumsurfaceincreasesMorebloodsurfaceInfluenceuterinecontractionirregularorincreasedmenstrualbleeding2.Lowerabdominalmasshardmassnotendernesslocaldiscomfort3.Painrarelyhappenusuallyduetocomplicationsreddegenerationtorsionofpedunculatedsubserousmyomaexpellingofsubmucousmyoma4.Pressureeffects

cervicalmyomaurinationfrequencyandurgencyofurinationdifficultyinurinationretentionofurineconstipation5.Effectsonpregnancyandchildbearingsubmucous,intramuralinfertility(inabilitytoconceive)abortionobstructbirthcanal,difficultlaborClinicalFindingsSigns1.enlargementoftheuterus

symmetricalenlargement:submucousasymmetrical~:intramural,subserous2.tumorpassthroughcervicalcanalDiagnosisSymptomsPhysicalsignsUltrasoundscanningSpecialexaminations:Hysteroscopy

UltrasounddetectedanabnormalechointheuterinecavityAsubmucousmyomawasverifiedbyhysteroscopyDifferentialDiagnosisPregnancyAdenomyosis

OvariantumorsTreatmentdependsonsymptoms,sizeandlocation,age,generalhealth,patients’desire

every3～6monthssmallmyomawithnosymptomclosetomenopause1.ObservationorFollow-up

pretreatmentforsurgerycontraindicatedforsurgery2.

Medicaltreatment(1)

Heavyorprolongedbleeding,especiallycausinganemia(2)

Torsionofsubserousmyoma(3)

Myomawithpressureeffects(4)Myomawhichcauseinfertilityandrecurrentabortion(5)Possiblemalignantchange3.SurgicaltreatmentA.Myomectomy

preservefertilityoruterusB.Hysterectomy

subtotal~total~transabdominal,transvaginal,laparoscopy,hysteroscopyHowtoconsult:Apainfeeling?Bmenstrualchanges?Chowtofind,location?Dsize,number?Eage,desireforfuturepregnancy?WordsforlearningIntramuralmyoma肌壁間肌瘤Subserousmyoma漿膜下肌瘤Submucousmyoma黏膜下肌瘤falsecapsule假包膜whorledstructure漩渦狀結(jié)構(gòu)Hyalinedegeneration玻璃樣變形Cysticdegeneration囊形變Calcification