Leiomyomas

Uterine LeiomyomaUterine Leiomyoma

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leiomyomata

Uterine fibroids

myoma

fibromyoma


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)


LocationLocation


LeiomyomaLeiomyoma


LeiomyosarcomaLeiomyosarcoma


PrevalencePrevalence

20-30% of reproductive-age women20-30% of reproductive-age women Most common indication for surgery Most common indication for surgery

in U.S. womenin U.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]


Risk factorsRisk factors

African American African American NonsmokingNonsmoking ObeseObese PerimenopausalPerimenopausal Gene mutationsGene mutations


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 Hereditary Leiomyomatosis and Renal

Cell Carcinoma (HLRCC) [6]Cell Carcinoma (HLRCC) [6] Cutaneous and uterine leiomyomataCutaneous and uterine leiomyomata At risk for papillary renal cell carcinoma At risk for papillary renal cell carcinoma

(women > men) [7,8](women > men) [7,8] Women: increased risk of leiomyosarcoma Women: increased risk of leiomyosarcoma

[7,8][7,8] Mutation in fumarate hydratase geneMutation in fumarate hydratase gene


Signs and SymptomsSigns and Symptoms BleedingBleeding PressurePressure PainPain InfertilityInfertility Pregnancy complications: cesarean Pregnancy complications: cesarean

delivery, breech presentation, delivery, breech presentation, malposition, preterm delivery, placenta malposition, preterm delivery, placenta previa, severe postpartum hemorrhage [9]previa, severe postpartum hemorrhage [9]

50-60% Asymptomatic50-60% Asymptomatic


DiagnosisDiagnosis

HistoryHistory Bimanual pelvic or abdominal examBimanual pelvic or abdominal exam Pelvic ultrasound - most commonPelvic ultrasound - most common MRI, HSG, sonohystogram, MRI, HSG, sonohystogram,

hysteroscopyhysteroscopy


TreatmentTreatment

Expectant management - most casesExpectant management - most cases Indications for treatmentIndications for treatment

Abnormal uterine bleeding, causing Abnormal uterine bleeding, causing anemiaanemia

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


Treatment ChoicesTreatment Choices

Medical therapiesMedical therapies Medroxyprogesterone (Provera)Medroxyprogesterone (Provera) DanazolDanazol GnRH agonists (nafarelin acetate, GnRH agonists (nafarelin acetate,

Depot Lupron)Depot Lupron)



MyomectomyMyomectomy HysteroscopicallyHysteroscopically LaparoscopicallyLaparoscopically AbdominallyAbdominally



Uterine Artery Embolization (UAE)Uterine Artery Embolization (UAE)


Treatment Choices:Treatment Choices:MR guided Focused MR guided Focused

UltrasoundUltrasound



HysterectomyHysterectomy VaginalVaginal AbdominalAbdominal


Gene TherapyGene Therapy

Gene-based vectors [13]Gene-based vectors [13] Dominant-negative form of estrogen Dominant-negative form of estrogen

receptor to inactivate estrogen receptor to inactivate estrogen signaling and induce apoptosis [13]signaling and induce apoptosis [13]


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 Abnormal uterine bleeding, causing anemiaanemia

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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Leiomyomas