Leiomyoma子宫平滑肌瘤课件.ppt

Uterine Leiomyoma 子宫平滑肌瘤 ( myoma ， fibroid ) Hua Linghu 令狐华 Department of Obs/Gyn Prevalence/incidence 25% - 50% reproductive women Increased incidence with age Age incidence 20-30yr 4 % 30-40yr 11-18% 40-50yr 33 % Lurie ? S, Piper ? I, Woliovitch ? I, Glezerman ? M. ? Age-related prevalence of sonographically confirmed uterine myomas. ? J Obstet Gynaecol . ? 2005;25:42 – 4 Etiology/Epidemiology Etiology unknown Increased risk factors 40 years or older Family history of uterine fibroid Nulliparity Obesity Black race Associated Factors Female Hormones - -- Estrogen ( 雌激素 )/ Progestron ( 孕激素 ) Clinical evidences: Reproducutive patients No cases before puberty No new cases after menopause( 停经 ) Increased during pregnancy Estrogen receptor (ER- α ) high concentration in black women Intramural ~(60%--70%) 肌壁间 Subserous(20%) 浆膜下 Submucous ~(10%) 粘膜下 Cervical ~ -2% Classification I ClassificationII Single Multiple Pathology ---gross structure Frequently multiple Firm, vary in size Spherical or irregularly lobulated False capsule ( 假包膜 ) Whorled appearance ( 漩涡 状结构 ) Pathology ---microscopic structure Hyaline ? 玻璃样变性 yellow, soft gelatinous areas Cystic ? 囊性变 liquefaction follows extreme hyalinization Red (carneous) degeneration 红色变性 Edema hypertrophy ? impede blood supply ? aseptic degenration infarction with venous thrombosis hemorrhage Other changes calcification 钙化 hemorrhage 出血 necrosis 坏死 SECONDARY CHANGES/ DEGENERATION Hyaline / Cystic Degeneration Red (carneous) degeneration Usually occurs during pregnancy Malignant Transformation rare 0.1-0.5% leiomyoma leiomyosarcoma Increased cell number Pathological nuclear fission 病理性核分裂 Depend on location , size , changes pregnancy status Clinical Findings Abnormal uterine bleeding most common 30% Heavy / prolonged bleeding (menorrhagia 月经过多 ) ----submucous/large