Leiomyomas

1. Uterine LeiomyomaUterine Leiomyoma
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2. Uterine LeiomyomaUterine Leiomyoma
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leiomyomata
Uterine fibroids
myoma
fibromyoma

3. Uterine LeiomyomaUterine Leiomyoma
Benign neoplasm of smooth muscleBenign neoplasm of smooth muscle
Estrogen sensitiveEstrogen sensitive
Surrounded by pseudocapsuleSurrounded by pseudocapsule
Rare malignant potential Rare malignant potential
(Leiomyosarcoma)(Leiomyosarcoma)
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4. LocationLocation
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5. LeiomyomaLeiomyoma
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6. LeiomyosarcomaLeiomyosarcoma
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7. PrevalencePrevalence
20-30% of reproductive-age women20-30% of reproductive-age women
Most common indication for surgery in Most common indication for surgery in
U.S. womenU.S. women
1/3 of all hysterectomies1/3 of all hysterectomies
3-fold higher incidence rate in Black 3-fold higher incidence rate in Black
women [1,2]women [1,2]
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8. Risk factorsRisk factors
African American African American
NonsmokingNonsmoking
ObeseObese
PerimenopausalPerimenopausal
Gene mutationsGene mutations
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9. Genetic basis?Genetic basis?
Twin studies [3]Twin studies [3]
First-degree affected relatives [4,5]First-degree affected relatives [4,5]
Race as risk factorRace as risk factor
Hereditary Leiomyomatosis and Renal Cell Hereditary Leiomyomatosis and Renal Cell
Carcinoma (HLRCC) [6]Carcinoma (HLRCC) [6]
Cutaneous and uterine leiomyomataCutaneous and uterine leiomyomata
At risk for papillary renal cell carcinoma (women > At risk for papillary renal cell carcinoma (women >
men) [7,8]men) [7,8]
Women: increased risk of leiomyosarcoma [7,8]Women: increased risk of leiomyosarcoma [7,8]
Mutation in fumarate hydratase geneMutation in fumarate hydratase gene
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10. Signs and SymptomsSigns and Symptoms
BleedingBleeding
PressurePressure
PainPain
InfertilityInfertility
Pregnancy complications: cesarean delivery, Pregnancy complications: cesarean delivery,
breech presentation, malposition, preterm breech presentation, malposition, preterm
delivery, placenta previa, severe postpartum delivery, placenta previa, severe postpartum
hemorrhage [9]hemorrhage [9]
50-60% Asymptomatic50-60% Asymptomatic
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11. DiagnosisDiagnosis
HistoryHistory
Bimanual pelvic or abdominal examBimanual pelvic or abdominal exam
Pelvic ultrasound - most commonPelvic ultrasound - most common
MRI, HSG, sonohystogram, hysteroscopyMRI, HSG, sonohystogram, hysteroscopy
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12. TreatmentTreatment
Expectant management - most casesExpectant management - most cases
Indications for treatmentIndications for treatment
Abnormal uterine bleeding, causing anemiaAbnormal uterine bleeding, causing anemia
Severe pelvic painSevere pelvic pain
Large or multipleLarge or multiple
Obscuring evaluation of adnexaeObscuring evaluation of adnexae
Urinary tract symptomsUrinary tract symptoms
Postmenopausal or rapid growthPostmenopausal or rapid growth
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13. Treatment ChoicesTreatment Choices
Medical therapiesMedical therapies
Medroxyprogesterone (Provera)Medroxyprogesterone (Provera)
DanazolDanazol
GnRH agonists (nafarelin acetate, Depot GnRH agonists (nafarelin acetate, Depot
Lupron)Lupron)
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14. Treatment ChoicesTreatment Choices
MyomectomyMyomectomy
HysteroscopicallyHysteroscopically
LaparoscopicallyLaparoscopically
AbdominallyAbdominally
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15. Treatment ChoicesTreatment Choices
Uterine Artery Embolization (UAE)Uterine Artery Embolization (UAE)
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16. Treatment Choices:Treatment Choices:
MR guided Focused UltrasoundMR guided Focused Ultrasound
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17. Treatment ChoicesTreatment Choices
HysterectomyHysterectomy
VaginalVaginal
AbdominalAbdominal
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18. Gene TherapyGene Therapy
Gene-based vectors [13]Gene-based vectors [13]
Dominant-negative form of estrogen receptor Dominant-negative form of estrogen receptor
to inactivate estrogen signaling and induce to inactivate estrogen signaling and induce
apoptosis [13]apoptosis [13]
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19. Follow-up (Treatment)Follow-up (Treatment)
Monitor size and location of fibroidsMonitor size and location of fibroids
Indications for treatmentIndications for treatment
Abnormal uterine bleeding, causing anemiaAbnormal uterine bleeding, causing anemia
Severe pelvic painSevere pelvic pain
Large or multipleLarge or multiple
Obscurrng evaluation of adnexaeObscurrng evaluation of adnexae
Urinary tract symptomsUrinary tract symptoms
Postmenopausal or rapid growthPostmenopausal or rapid growth
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