复旦妇产科大课课件：子宫肌瘤徐丛剑

子宫肌瘤Leiomyomasofuterus复旦大学妇产科医院徐丛剑LeiomyomasofuterusCommonesttumors25%ofwomen，20%offemale>30ydohavefibroid.

Alsocalledas“Fibroids”Estrogenresponsive,regressaftercastrationormenopause.Oftenrapidincreaseduringpregnancyor

duringoralcontraceptiveuse,andregressaftermenopauseWhorlsofsmoothmuscle,welldemarcatedAsymptomatic,bleedingorPressonbladderAbortion,malpresentationetc.Causes

Unknown.Hyperestrogenemia？ Highresponsetoestrogen?HeredityUterineleiomyoma

Corporeal90%multiple

Cervical10%solitary

Uterine

leiomyoma

submucus

15%notcapsulatedSubserous

20%

Interstitial65%Submucous

myomahttp://LeiomyomataUterusCUTSECTIONWelldemarcatedsurroundingmuscle.whorly(interminglingmusclefibersandfibroustissue).Palerthansurrounding(Ischaemia).DegenerationLeiomyomasenlargeoutgrowtheirbloodsupplyvarioustypesofdegenerationHyalinedegenerationCysticdegenerationReddegeneration-duringpregnancy,secondarytovenousthrombosiswithintheperipheryofthetumororruptureofintratumoralarteriesSarcomatous

change-lessthan3%DegenerationwithcalcificationSYMPTOMSBleeding

menorrhagia

metrorrhagiaPain

congested

Dysmenorrhea

degeneration

infection

torsionInfertility,Abortionmass.Discharge.Pressuresymptoms.SignsSymmetricallyenlargeduterus(submucosalfibroid).Asymmetricallyenlargeduterus(subserousfibroid)DIFFERENTIALDiagnosisADEMOMYOSIS-presenceofectopicendometrialglandsandstromawithin

themyometrium,whichareassociatedwithreactivehypertrophy

ofthesurroundingmyometrialsmoothmuscle-mostcommonlyadiffuseabnormalitybut

mayalsooccurasafocalmass,whichisknownasanadenomyoma-diffuseformofadenomyosisappearsasa

thickenedjunctionalzone(innermyometrium)onT2-weighted

imagesUterusAdenomyosis:DifferentialDiagnosisUterineLeiomyosarcoma-mayariseinapreviouslyexistingbenignleiomyoma

(sarcomatoustransformation)orindependentlyfromthesmooth

musclecellsofthemyometrium-Althoughithasbeensuggested

thatanirregularmarginofauterineleiomyomaatMRimaging

issuggestiveofsarcomatoustransformation,the

specificityofthisfindinghasnotbeenestablished-Adiagnosisofleiomyosarcomais

establishedhistologicallybynotingthepresenceofinfiltrative

margins,nuclearatypia,andincreasedmitoticfiguresLeiomyosarcoma:TreatmentofLeiomyomaNotreatmentConservativeSurgicalMyolysis.UterineA

embolization.Patient(age-parity-symptoms).Fibroid(number-size-type)Complications.SURGICAL

Myomectomy

Hysterectomy.TraditionalmicrosurgicalMedicalAndrogen:GnRHaMifepristoneTCMPregn