妇产科教学课件：Uterine myoma and sarcoma.pptVIP

* * . * . * * * * , . Case discussion History : A 33 year old woman complains heavy bleeding during period for 1 year. The duration of bleeding usually lasts 9 days. Sometimes she has blotting. Physical examination : shows pale and short of breath. Pelvic examination revealed enlarged uterus with a size of two-month pregnancy. Case discussion Ultrasound: A 65/55/50 mm low-echoes mass with clear margin in myometrium was seen by ultrasound. In addition, a 23/20/19mm low echoes mass protrudes from uterus cavity. Lab test: Hb: 80g/L. Questions What ‘s the diagnosis ? ( give the evidence) Which diseases should be excluded? What is the suitable treatment? Does this treatment affect fertility? Take home message About the myoma The symptoms are related to the types of location and degenerations. Half of the patients are asymptomatic. The commonest symptom is change of mense. Ultrasound is the common and accurate diagnostic tool. Take home message About the myoma No treatment is required for asymptomatic patients. Medications are suitable for peri-menopausal patients with mild symptoms. Surgery is the effective way to treat symptomatic patients or suspicious for sarcomatous change. Take home message About the sarcoma Rare tumors with poor prognosis The commonest symptom is irregular vaginal bleeding with pain. Diagnosis is by pathology results. Surgical treatment is the main option. Adjunvant therapy depends on stage and type. * * * * Medication Indications: Size = 2 months pregnant uterus Mild symptoms Peri-menopausal  With contraindications for operation Gonadotropin-releasing hormone agonist (GnRH-a) Mechanism: Inhibit FSH, LH and Estrogen Efficacy : 40~60% decrease in uterine volume Side effects: hypo-estrogenism reversible bone loss and hot flashes obvious for long use (6 months) estrogen add-back therapy