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    Benign Tumors of Uterus

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    Zunaira Zahra
    (1) Benign tumors of the uterus include uterine polyps, fibroids, and adenomyomas. Uterine polyps can be endometrial, adenomyomatous, or placental in origin. (2) Uterine fibroids are the most common benign tumors, arising from the myometrium. They can cause symptoms like abnormal bleeding, pain, or pressure. Treatment options include myomectomy, hysterectomy, uterine artery embolization, or myolysis. (3) Case examples demonstrated different presentations of fibroids including a polypoid fibroid, degenerating fibroid, fibroid causing

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    Benign Tumors of Uterus

    Uploaded by

    Zunaira Zahra
    46 views44 pages
    (1) Benign tumors of the uterus include uterine polyps, fibroids, and adenomyomas. Uterine polyps can be endometrial, adenomyomatous, or placental in origin. (2) Uterine fibroids are the most common benign tumors, arising from the myometrium. They can cause symptoms like abnormal bleeding, pain, or pressure. Treatment options include myomectomy, hysterectomy, uterine artery embolization, or myolysis. (3) Case examples demonstrated different presentations of fibroids including a polypoid fibroid, degenerating fibroid, fibroid causing

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    Benign tumors of uterus

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    (1) Benign tumors of the uterus include uterine polyps, fibroids, and adenomyomas. Uterine polyps can be endometrial, adenomyomatous, or placental in origin. (2) Uterine fibroids are the most common benign tumors, arising from the myometrium. They can cause symptoms like abnormal bleeding, pain, or pressure. Treatment options include myomectomy, hysterectomy, uterine artery embolization, or myolysis. (3) Case examples demonstrated different presentations of fibroids including a polypoid fibroid, degenerating fibroid, fibroid causing

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    Download as pptx, pdf, or txt
    46 views44 pages

    Benign Tumors of Uterus

    Uploaded by

    Zunaira Zahra
    (1) Benign tumors of the uterus include uterine polyps, fibroids, and adenomyomas. Uterine polyps can be endometrial, adenomyomatous, or placental in origin. (2) Uterine fibroids are the most common benign tumors, arising from the myometrium. They can cause symptoms like abnormal bleeding, pain, or pressure. Treatment options include myomectomy, hysterectomy, uterine artery embolization, or myolysis. (3) Case examples demonstrated different presentations of fibroids including a polypoid fibroid, degenerating fibroid, fibroid causing

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    BENIGN TUMORS OF

    UTERUS
    Prof. Dr. Tahira Rizwan
    UTERINE POLYPS
     Polyp is composed of endometrial stroma and
    glands covered by a single layer of columnar
    epithelium.
     Commonest in the uterine corpus.

    POLYPS CAN BE
     ENDOMETRIAL
    Simple _______ local exageration of generalized
    endometrial hyperplasia.
    Malignant ______rare
     ADENOMYOMATOUS _____have smooth
    muscle and endometrial elements.

     FIBROID

     PLACENTAL POLYP___organization of
    small pieces of retained placental tissue
    Clinical Features
     Abnormal uterine bleeding
     Intermenstrual bleeding
     Postcoital bleeding
    TREATMENT

     Polypectomy and D & C.

     Hysteroscopicalyguided polypectomy
    and endometrial sampling.
    UTERINE FIBROIDS
     Most common benign tumor of
    female genital tract, arising from
    uterine myometrium

     50% of women – atleast one identifiable


    fibroid at menupause
    AETIOLOGY
     Still unknown. Possibly multifactorial genetic
    inheritance pattern.
     Growth dependent on ovarian hormones,
    Progesterone receptors
     Role of peptide growth factors

    I G F -1
    I G F -2
    EGF
    FGF
    TGF
    CLASSIFICATION &
    PATHOPHYSIOLOGY
    Four subgrougs
    A -Subserosal – pedunculated
    sessile
    parasitic
    broad ligament
    B -Intramural
    C - Submucosal - Polypoidal
    sessile
    D - Cervical
    MACROSCOPICALLY

    Round / 0val – shaped, firm ,with typical white whorled


    appearance enclosed in false capsule.

    MICROSCOPICALLY

    Smooth muscle cell bundles arranged in whorl like


    patterns
    COMPLICATIONS
    1 Degenerative changes
    - Hyaline Degeneration
    - Cystic Degeneration
    - Red Degeneration
    - Calcification

    11 – Infection
    111 – Torsion
    1V – Sarcomatous change.
    CLINICAL PRESENTATION OF FIBROIDS.

    Asymptomatic >50%
    Menorrhagia
    Intermenstrual bleeding / postcoital bleeding in fibroid polyp
    Pelvic pain - Torsion
    - Degeneration
    - Infection
    - Sarcomatous change
    Dysmenorrhoea
    Pressure symptoms
    - Frequency of micturition
    - Stress incontinence
    - Hydroureter / Hydronephrosis
    - Hemorrhoids
    Abdominal lump
    Infertility
    - impaired implantation
    - impaired tubal transport
    Repetitive pregnancy loss
    INVESTIGATIONS
     Baseline
     Ultrasound

     Ct scan or MRI

     Sonohysterography

     Hysterosalpingography

     Hysteroscopy – rules out other pathology like


    endometrial adhesions, uterine septae, endometrial
    polyp.
     Laparoscopy - uterus < 12weeks size
    - infertility
    - pain
    TREATMENT METHODS

    The most critical questions preceding decision


    making
    a) Is future reproduction desired?
    b) How soon can menupause be anticipated ?
    Expectant management
    - Asymptomatic fibroids
    – Uterus size <12weeks
    – Diagnosis – certain
    – Menopause – imminent
    INDICATIONS FOR TREATMENT
     Symptomatic fibroids
     Diagnosis in doubt
     An asymptomatic fibroid causing pressure on
    the ureter
     Rapid growth in a menupausal woman
     Infertility caused by cornual fibroid &
    habitual abortion due to submucous fibroid
    TREATMENT

    Medical

    Surgical
    MEDICALTREATMENT
    OBJECTIVES
    1. Relief of symptoms
    2. Reduction in fibroid size

     Iron therapy for anemia


     Drugs used to control menorrhagia
    Gn RH analogues
    Preoperatively
    Premenupausal women
    Volume of leiomyomata decreases by 35-50% after 6months
    treatment.
    SURGICAL TREATMENT
    CONSERVATIVE SURGERY - MYOMECTOMY
    Removal of all identifiable leiomyomata with the least – possible
    alteration of the reproductive tract
    INDICATIONS
     Infertile woman
     A woman desirous of child bearing and wishing to retain the
    uterus
    ROUTES
    Abdominal
    Vaginal Submucous Fibroid polyp
    Hysteroscopic
    Submucosal fibroid predominantly in
    endometrial cavity
    Preop. Use of GnRH agonist
    Myomectomy
    SURGICAL TREATMENT
    HYSTERECTOMY.
     family complete
     Further pregnancy unlikely
     When associated with malignancy

    BENEFITS
     Permanent relief of symptoms
     Prevention of recurrence
     Permanent contraception
     Improved quality of life
    ROUTES
     Abdominal
     Vaginal
    - mobile uterus
    - size less than 14 weeks
    - no other pelvic pathology
     Laparoscopically assisted vaginal
    hysterectomy

    * Preop use of Gn RH agonist


    * Difficult surgery – broad ligament fibroid
    - cervical fibroid
    - pelvic adhesions.
    NEW TREATMENT MODALITIES
    MYOLYSIS
     Experimental
     Repeated insertion of a surgical probe of some sort
    into the tumor typically at laparoscopy & causing
    tissue injury by

    a) Monopolar / Bipolar electrocautery


    b) Laser lyper therminal
    c) Fibre laser vaporization
    d) Diathermy.
    e) Cryotherapy
    UTERINE ARTERY
    EMBOLIZATION
     OBJ – to occlude both uterine arteries with
    particulate emboli – Ischemic necrosis of the uterine
    fibroids.
     Specialist Angiography suite by experienced
    interventional radiologist.
     Indications

    when menorrhagia - the primary clinical symptom


    & either surgery is contraindicated or the pt. declines
    extirpative surgery.
    - Long term safety and efficacy remains to be
    demonstrated particularly in women wishing to retain
    fertility.
    Complications
     Failure to cannulate the relavant artery
     Local hematoma formation or thrombosis.

     Femoral arterial damage

     Severe pain

     Borderline pyrexia

     Serious infection

     Amenorrhea

     Premature ovarian failure

     Pulmonary embolism.

     Death.
    Leiomyosarcoma
     ORIGIN
    - De novo
    - Sarcomatous change in fibroid
     Incidence - 0.5% of all myomas

     Most frequently in women between the ages of 40


    and 50
    May occur in post menopausal women
     Rapid enlargement of uterus with profuse irregular
    vaginal bleeding ass. with pain
    Macroscopically
    yellowish grey in colour and haemorrhagic consistency
    soft and friable

    Microscopically
     High cellularity
     Nuclear pleomorphism
     Areas of necrosis and infiltrating margins
     High mitotic rate with abnormal mitosis (> 10 / 10 /HPF

    TREATMENT
     TAH + BSO
     Radiotherapy
     Chemotherapy – In case of distal metastasis.
    FIBROIDS AND PREGNANCY
    EFEECT OF PREGNANCY ON FIBROIDS

     Enlargement and softening of fibroid


     Red degeneration

     Torsion of a pedunculated fibroid

     Infection
    EFFECT OF FIBROIDS ON PREGNANCY

     Abortion
     Preterm labour
     IUGR
     Accidental haemorrhage
     Abnormal lie / presentation
     Obstructed labour
     Postpartum haemorrhage
     Puerperal sepsis
    CASE 1
    POLYPOID PRESENTATION
    Age 40years
    P5 Ao (SVDS) LCB=16 YEAR
    Known Diabetic - 1 year (diet control)
    P/c Heavy periods and difficulty in
    passing urine -1 year
    0/E Pallor +
    P/S 5X6cm polypoidal mass protruding
    through os
    P/V uterus 10-12 wks size
    USG 8x5.5 cm fibroid in
    supracervical region
    Hb 5.1gm % -Blood transfusion given
    Operation – Total abdominal hysterectomy
    Postop Recovery – Smooth
    H/P - Proliferative endometrium
    fibroid polyp.
    CASE-2
    LEIOMYOSARCOMA
    Age 55years P8 Ao (SVDs) LCB - 20years
    Postmenopausal 4years
    Known hypertensive -2 years –on irregular medication

    P/C Abdominal mass ass. with


    pain – 6-7 months

    O/E 26 weeks size abdominal mass firm nodular


    contour, restricted mobility , arising from pelvis.

    USG Bulky uterus containing mutliple


    fibroids pressing over the Rt-ureter causing
    hydronephrosis.
    CT SCAN Large pedunculated / subserosal fibroid 11.5x
    10.7x20cm pressing on right upper ureter
    Hb 8.8gm %
    Blood transfusions given
    OPERATION. Exploratory laparotomy
    I/O F 20x20cm mutli lobulated mass fleshy
    appearance adherent with Rt. Infundibulopelvic
    ligament and gut.
    Removol of mass + TAH +BSO
    Postop recovery smooth
    H/P Leiomyosarcoma
    Pt. referred to oncology Deptt.for radiotherapy
    CASE-3
    ASSOCIATION WITH INFERTILITY
    DEGENERATIVE CHANGES
    Age 42years
    M – 16 years Nulliparous
    LMP 6 Months ago
    P/C Abdominal mass – 1 year + pain
    O/E 16 weeks size lower abdominal mass
    arising from pelvis
    P/V uterus enlarged to 16 weeks size
    USG Bulky urerus showing a large
    heterogenous area 11x9.8cm with small cystic
    space
    CT SCAN- Degenerating myometrial fibroid Rt.Pelvic kidney
    IVU Rt kidney pelvic in position, excreting the
    contrast normally
    Operation = Exploratory laparotomy
    I/O F Large fundal fibroid 6x8 cm
    Rt pelvic kidney
    Dense pelvic adhesions
    Myomectomy done
    Postop recovery Smooth
    H/P Leiomyoma uteri
    CASE IV
    FIBROID WITH PREGNANCY
    Age = 38 yrs
    G 5 P 4 (Last LSCS)
    Known diabetic & hypertensive – 2 yrs
    Presented at 33 + wks with preterm premature rupture of membranes.
    Menstrual h. – Menorrhagia & dysmenorrhoea for 1 yr. prior to this
    pregnancy.
    USG
    Fetal maturity – 29-30 wks.
    Adequate liquor
    Rt. Sided fibroid 8 x 10 cm.
    Management
    Control of diabetes and hypertension
    Conservative management regarding PPROM.
    Operation
    El. LSCS + BTL – 36 wks.
    I/O – Fibroid on right side of uterus extending into broad ligament 8 x 10 cm.
    Postoperative recovery – Smooth
    Plan – To manage the fibroid after 3 months.

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