子宫肌瘤课件.pptVIP

子宫肌瘤 Leiomyomas of uterusCommonest tumors 25% of women，20% of female 30y do have fibroid. Also called as “Fibroids”Estrogen responsive, regress after castration or menopause.Often rapid increase during pregnancy or during oral contraceptive use, and regress after menopauseWhorls of smooth muscle, well demarcatedAsymptomatic, bleeding or Press on bladderAbortion, malpresentation etc. Causes Unknown.Hyperestrogenemia？ High response to estrogen?Heredity Uterine leiomyoma Corporeal 90%multiple Cervical 10%solitary Uterine leiomyoma submucus 15%not capsulated Subserous 20% Interstitial 65% Submucous myoma Leiomyomata Uterus CUT SECTIONWell demarcated surrounding muscle.whorly (intermingling muscle fibers and fibrous tissue).Paler than surrounding (Ischaemia). DegenerationLeiomyomas enlarge outgrow their blood supply various types of degeneration Hyaline degeneration Cystic degenerationRed degeneration - during pregnancy, secondary to venous thrombosis within the periphery of the tumor or rupture of intratumoral arteries Sarcomatous change -less than 3%Degeneration with calcification SYMPTOMSBleeding menorrhagia metrorrhagiaPain congested Dysmenorrhea degeneration infection torsionInfertility, Abortionmass.Discharge.Pressure symptoms. SignsSymmetrically enlarged uterus(submucosal fibroid).Asymmetrically enlarged uterus(subserous fibroid) DIFFERENTIAL DiagnosisADEMOMYOSIS - presence of ectopic endometrial glands and stroma within the myometrium, which are associated with reactive hypertrophy of the surrounding myometrial smooth muscle - most commonly a diffuse abnormality but may also occur as a focal mass, which is known as an adenomyoma - diffuse form of adenomyosis appears as a thickened junctional zone (inner myometrium) on T2-weighted images Uterus Adenomyosis: Differential DiagnosisUterine Leiomyosarcoma - may arise in a previously existing benign leiomyoma (sarcomatous transformation) or independently from the