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8/20/2019 Tugas Kepaniteraan OBGYN
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2003-11-3 1
Myoma of UterusXu Hong
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Synonyms
leiomyoma of uterus
leiomyomas
fibromyomas
myofibromas
fibroids
fibromas
myomas
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Incidence
Most common solid pelvic tumors
Develop in 20~ 25% of women duringreproductive years
30~ 50 years old
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Correlative Factors
n estrogenic milieu may be necessary
!rogesterone function
"rowt# factor and t#eir receptor :
epit#elial growt# factor ( $") &nsulin-li'e growt# factor ( &")
platelet-derived growt# factor
puberty
青春期
menopause
绝经期
estrogen
雌激素 progesterone
孕激素
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Pathology
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Gross Appearance
)are only a single, usually many e*ist
+ell-circumscribed, nonencapsulated
pseudocapsule is present,
#e consistency is usually firm or even #ard e*ceptw#en degeneration or #emorr#age #as occurred,
color : lig#t gray or pin'is# w#ite
cut section: an intertwining pattern or
a w#orl-li'e arrangement; bulgy
pseudocapsule
假包膜
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/moot# muscle tumors of t#e uterus are oftenmultiple, /een #ere are submucosal intramuraland subserosal leiomyomata of t#e uterus,
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Microscopic
Appearanceomposition: smoot# muscle
connective tissue
#e nonstriated muscle fibers are arranged
in bundles of various sies t#at run in
multiple directions,
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Classication
1
ccording to growt# location :
Myomas on t#e body of uterus( 0%)
Myomas on t#e cervi* of uterus( 10%)
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Classication
ccording to t#e relation to uterine muscle:
/ubmucous
(10~
15%)
&ntramural( (0 ~ .0%)
/ubserosal( 20%)
ew leiomyomas are actually of a single 6pure7 type,
8 #ybrids
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Clinical
Manifestation
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Symptoms
menorr#agia and prolonged menstrual period :common
!elvic pain: occurs in pregnancy if undergoing degeneration ortorsion of a pedunculated myoma
!elvic pressure: urinary fre9uency
bowel difficulty( constipation)/pontaneous abortion
&nfertility
menorr#agia
月经过多
pedunculated
有蒂的
spontaneous abortion
自然流产
infertility
不育症
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Signs
palpable abdominal tumour
!elvic e*amination:
uterus 8 enlarged and irregular ;
#ard
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!egeneration
:yaline degeneration
ystic degeneration
)ed degeneration
/arcomatous c#ange
#e ot#ers:
fat degeneration calcification
t#e secondary infection
)esult from t#e diminis#ed
vascularity of t#e
connective-tissue element
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"ed !egeneration
;ccasionally seen as a complication of pregnancy( during pregnancy or immediate postpartum period)
#e pat#ogenesis is un'nown,may be t#e result of t#eaccumulation of blood in t#e tumour because of venous
obstruction,
#e cut surface resembles raw meat,
linical features: a cause of pain( acute)
fever rapid growt#, tender
产期
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:ere is a very largeleiomyoma of t#e uterus
t#at #as undergone
degenerative c#ange and is
red , /uc# anappearance mig#t ma'e
you t#in' t#at it could be
malignant, )emember t#at
malignant tumors do notgenerally arise from benign
tumors,
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Sarcomatous Change
)are: 0,4%~ 0,%
More common at 40~ 50 years old
?sually occur in intramural fiboids
grow 9uic'ly
vaginal bleeding
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!iagnosis
:istory
@imanual e*amination
?ltrasonograp#y ( @!ultrasound e*amination)
:ysteroscopy
Aaparoscopy
:ysterograp#y
#ysteroscopy
"#$%&
laparoscopy'($%&
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!i#erential !iagnosis
!regnancy
;varian tumour
denomyosis
Malignant tumors of uterus
sarcoma of uterus
endometrial carcinoma
cervical cancer
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$reatment
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%&servation and Follo'Up
/mall, asymptomatic fibroids need not be
treated, especially near menopause,
&nterval: 3~ ( mont#s
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Medical $reatment
ndrogenic agents: testosterone propionate
"n):-a: induce a #ypoestrogenic pseudomenopausalstate
not recommended for longer t#an ( mont#s 6add-bac'7 regimens
)*
+,-./0,12/0
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Surgery
$reatment 1 &ndications:
greater t#an 10 wee'sB gestational sie
menorr#agia, lead to anemia
#ave pressure symptoms
grows rapidlyfailure of medical treatment
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Surgery
$reatment Met#od:
Myomectomy8conservative t#erapy
preserve fertility
significant ris' of recurrence
:ysterectomy8 radical t#erapy
/ubtotal #ysterectomy
#ysterectomy
"#345
myomectomy
67845
;nly true 6cure7
for leiomyomas
9:"#345
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Surgery
$reatment (
pproac#:
trans-abdominal
trans-vaginal
laparoscopic or #ysteroscopic
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&t is important to
individualie
t#e c#oice of
t#erapy,
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Uterine )eiomyomasComplicating Pregnancy
impact on pregnancy: abortion
impact on delivery: premature labour
fetal malpresentation
retained placenta
placenta previa
need for operative delivery
( birt# canal obstruction)
postpartum #emorr#age
onservative treatment
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Critical Points
May be related to superabundant estrogen,
+ell-circumscribed, nonencapsulated,
:ave a pseudocapsule,
an be classified into submucosal; intramural andsubserosal types,
Different types #ave different features,
Menorr#agia is common,
our degeneration types
&ndividualied treatment, includeobservation;medical treatment and surgical treatment,