Leiomyoma (Fibroids)

Snapshot

• A 30-year-old African American G0P0 with no significant past medical history presents with chronic pelvic pain. She denies any other symptoms. Physical exam reveals a mobile uterus that is nontender with multiple discrete nodules. A transvaginal ultrasound shows hyperechoic masses within the uteruine myometrium. She decides to undergo a myomectomy that will preserve her ability to bear children.

Overview

Introduction

• Otherwise known as fibroids
• Leiomyomas are smooth muscle growths of the uterine myometrium
• Epidemiology (most common)
  • benign uterine tumor
  • tumor in females
  • seen in African Americans (5x more common)
  • occurs in women 20-40 years of age
• Often present with multiple discrete tumors

Presentation

• Symptoms
  • sensitive to estrogen levels
    • tumor growth and increased symptoms during pregnancy
    • decreased symptoms during menopause
  • may present with
    • no symptoms
    • abnormal uterine bleeding
      • iron deficiency anemia
    • miscarriage
    • pain
    • constipation
    • urinary frequency 
• Physical exam
  • uterus is
    • enlarged
    • firm
    • asymmetric
    • nontender
• multiple tumors

Evaluation

• Diagnose with clinical history and exam
• Confirm with sonogram
  • transvaginal ultrasound has high sensitivity (95-100%)
  • hyperechoic, well-circumscribed round masses
• Labs
  • β-hCG to rule out pregnancy
• Histology 
• whorled pattern of smooth muscle bundles 

Differential Diagnosis

• Leiomyosarcoma 
• Adenomyosis 
• Endometrial polyp 
• Pregnancy

Treatment

• If asymptomatic
  • observation
    • fibroids can shrink substantially postpartum and after menopause
• If symptomatic
  • premenopausal
    • OCPs
    • NSAIDs
    • myomectomy
  • postmenopausal
    • myomectomy
• hysterectomy

Prognosis, Prevention, and Complications

• Prognosis
  • having symptomatic fibroids decreases quality of life
• Complications
  • very rarely (if at all) transforms into leiomyosarcoma
  • infertility