1、1 Uterine myoma2Definition and IntroductionnMyoma,fibroid,fibromyoma nOne of the most commonest tumors,present in 20-25%of reproductive-age womennBenign uterine neoplasms,composed primarily of smooth muscle345Pathogenesis nNot clearnEstrogen and its receptors in higher concentrationsnProgesterone ma
2、ybe accelerate the mitosis of cellsnHeredity(25%-50%):12,14,7 chromosome correlated with myoma6Pathology Grossly:nbuff-colorednroundednsmoothnfirm7Pathology Microscope:nIndividual cells are spindleshaped（梭（梭形）形）,have elongated nulcei,and are quite uniform in sizenFibre are intermixed with the smooth
3、 muscle bundles8Classification vaccording to the situation Corpus:90%Cervical:10%vaccording to the relationship between myoma and uterine wallSubmucous:10%-15%Intramural:60%-70%Subserous:20%9DegenerationnThe myoma lose the typical structure(the spiral shape)nBenign degeneration 1、hyaline 2、cystic 3、
4、red 4、calcificationnMalignant transformation:sarcomatous change(0.4-0.8%)10Clinical symptom nSymptoms:present in 35-50%patientsnSymptoms depend on the location,size,degeneration and whether or not the patient is pregnant11nAbnormal uterine bleedingnPainnPressure symptomsnInfertilitynSpontaneous abor
5、tionnMassClinical symptom12Clinical symptomSigns nAbdominal exam:nSpeculum exam:cervical myomanBimanual exam:The diagosis is obvious when the normal uterine contour is distorted by one or more smooth,spherical,firm masses,but often it is difficult to be absolutely certain that such masses are part o
6、f the uterus13Clinical symptom Laboratory and special examinationsnUltrasoundnLab exam:anemia(menorrhagia)nHysteroscopy:identification,removal submucousnLaparoscopy:the precise origin of myoma,myomectomy14DiagnosisnHistorynSymptoms and signsnSpecial exam:especially the outcomes of ultrasound15Differ
7、ential diagnosisnOvarian carcinomanHyperplasia and enlarged fallopian tubesnTubo-ovarian abscessnEndometriosisnPregnant uterusnpolypsnMalformation of uterus16Treatment17Principle of treatmentnDepends on the patients age,pregnancy status,desire for future pregnancies,general health,and symptomsnThe s
8、ize,location,and state of preservation of the myomas18Emergency measurenSevere Anemia:Blood transfusionnIndicate of emergency surgery:infected myoma(submucous)acute torsion intestinal obstruction usually caused by a pedunculated myoma19Medicine measuresnDo not require surgerynRule out the other caus
9、esnExamined every 6 months after diagnosis to monitoring growth of the myoma,whether it grows quickly20nNo definitive medicine therapy is currently available for myomanThe gonadotropin-releasing hormone agonists(GnRH-a)may be effective in limiting growth or causing a temporary decrease in tumor size
10、.21GnRH-a mechanisms:ninduce hypogonadism through pituitary desensitizationndownregulation of receptorsninhibition of gonadatropins22nJudgment must be individualizednUterine Size：beyond 10 weeks pregnancy nAnemia；oppressing symptom；infertility；habitual abortion；quickly growth and so onSurgical measu
11、re23nMyomectomy（肌瘤挖出术）（肌瘤挖出术）symptomatic patient who wish to preserve fertility or conserve the uterus hysteroscope:submucous myoma laparoscope:subserous myoma24D&Chysteroscope2526nHysterectomy by vaginal hysterectomy:vaginal relaxation demands repair of cystocele（膀胱膨出）（膀胱膨出）,rectocele（直肠（直肠膨出）膨出）,e
12、nterocele（肠疝）（肠疝）by abdominal hysterectomy27Surgical methodsLaparotomy（剖腹手术）（剖腹手术）Laparoscope（腹腔镜）（腹腔镜）Hysteroscope（宫腔镜）（宫腔镜）myomectomyhysterectomy28Advancement of treatmentnArterial embolismnHIFU(high intensity focus ultrasound)29Thanks!Submucous myomaIntramural myoma Subserous myoma33nHyaline dege
13、neration Mature or“old”myoma are white but contain yellow,soft,and often gelatinous（胶状）（胶状）areas of hyaline change.These tumors are usually asymptomatic*3435nCystic degeneration Liquefaction follows extreme hyalinization the liquid in the cavity and the myoma becomes soft*3637nRed degeneration Venou
14、s thrombosis and congestion with interstitial hemorrhage are responsible for the color of a myoma undergoing red degeneration.Usually occurs in pregnancy or puperium,the vortex myoma structure disappear38变性39nCalcificate degeneration Subserous leiomyoma are most commonly affected by circulatory depr
15、ivation,which causes precipitation of calcium carbonate and phosphate within the tumor*40Abnormal uterine bleedingPresent in up to 30%of patients,usually in submucous myoma nInterruption of the blood supply to the endometriumnDistortion and congestion of surrounding vesselsnUlceration of overlying e
16、ndometrium41nPrlonged,heavy menstruation (menorrhagia),premenstrual spotting,prolonged light staining following mensesnAny type of abnormal bleeding is possiblenCause the anemiaAbnormal uterine bleeding42Pelvic pain Degeneration associated with vascular occlusion,infection,torsion of a pedunculated
17、tumor,or myometrial contraction to expel myoma from the uterine cavity43Pressure symptomsnIntramural:distort or obstruct other organsnCervical myoma:vaginal discharge,bleeding;dyspareunia；infertility;compress the ureters,bladder,rectum44Infertility When myomas are entirely or mostly endocavity,use of surgery to improve fertility Myomas with large size influence the shape of the uterine cavity,cause the abortion45Spontaneous abortion The incidence of Spontaneous abortion secondary to myoma is unknown but is possibly 2 times the incidence in normal pregnant women.Arterial embolism47HIFU
