benign uterine masses part 1

Question 1

what are the most common benign lesions of the uterus ?

Answer 1

leiomyomata/fibroids

Question 2

what are other terms that mean leiomyomata ?

Answer 2

fibriods
fibromyomata
myomata

Question 3

what is the etiology of fibroids ?

Answer 3

hyperestrinism
growth factors
genetic factors

Question 4

what hormone is responsible for the growth of fibroids ?

Answer 4

oestrogen

Question 5

what are fibrioids commonly associated with ?

Answer 5

endometrial hyperplasia

Question 6

when do we most commonly see fibroids in women ?

Answer 6

in their child bearing period ( reproductive age zay el endometriosis ) , they cannot exist before puberty or after menopause

Question 7

what are the risk factors for leiomyomata ?

Answer 7

nulliparity ( never given birth)
obesity
positive family history
racial factor ( more common in black african women)

Question 8

why are women who have not given birth more liable to get fibroids ?

Answer 8

due to increased levels of oestradiol

Question 9

what are the different sites of fibroids ?

Answer 9

corporeal fibroid
cervical fibroid
broad ligament fibroid

Question 10

what are the types fibroids ?

Answer 10

interstitial myomata 
subserosa myomata 
submucosa myomata ( diagnosed by saline infusion sonography)
pedunculated SSM 
submucous fibroid polyp

Question 11

what is the pattern with
corporeal fibroids
submucosa fibroid polyp
cervical and broad ligament fibroids

Answer 11

corporeal fibroids - multiple
submucosa fibroid polyp - single
cervical and broad ligament fibroids- single

Question 12

why is the cut section of the fibroid paler than the myometrium ?

Answer 12

due to poor vascularity

Question 13

what is the nature of the fibroid capsule ?

Answer 13

a pseudo capsule of compressed normal myometrium

Question 14

what are the pathological changes in fibroids ?

Answer 14

atrophy 
hyaline degeneration 
cystic degeneration 
fatty degeneration 
calcification 
red degeneration 
necrosis 
infection 
vascular changes 
malignant changes

Question 15

why does atrophy happen in fibroids ?

Answer 15

due to diminished vascularity

Question 16

when do atrophic changes in fibroids happen ?

Answer 16

after menopause and during the post partum period

Question 17

what is the most common change in fibroids ?

Answer 17

hyaline degeneration

Question 18

how does cystic degeneration happen ?

Answer 18

due to absorption of liquified hyaline material

Question 19

what are the different forms that calcifications can take in fibroids?

Answer 19

peripheral calcification - egg shell

diffuse calcification - womb stone

Question 20

how can calcifications in fibroids be detected ?

Answer 20

Ultrasound

Question 21

what is red degeneration ?

Answer 21

hemorrhagic infarction of the uterine leiomyoma (incomplete necrosis)

Question 22

what is another term for red degeneration ?

Answer 22

necrobiosis

Question 23

when does red degeneration more commonly happen ?

Answer 23

during pregnancy

Question 24

what is a common present is the most common presentation with red degeneration ?

Answer 24

fishy odours
sudden severe abdominal pain
fever
vomiting

Question 25

what are the changes that may happen after torsion of a fibroid ?

Answer 25

``` vascular changes ( oedema and congestion) necrosis ```

Question 26

what are the malignant changes in fibroids ?

Answer 26

leiomyosarcoma

Question 27

when do we clinically suspect a leiomyosarcoma ?

Answer 27

fibroids presenting with postmenopausal bleeding rapid increase in size of myoma rapid recurrence after myomectomy post-menopausal growth of a pre-existing fibroid

Question 28

what is the effect of fibroids on the uterus ?

Answer 28

myometrium shows increased vascularity uterine cavity is enlarged uterus may be displaced in position

Question 29

what are the associated conditions with fibroids ?

Answer 29

endometrial and myometrial hyperplasia endometriosis adenomyosis endometrial carcinoma

Question 30

what is the effect of fibroids on the urethra ?

Answer 30

ureteric compression | lateral displacement of the ureter

Question 31

what are the features of a typical patient who may be suffering from a fibroid ?

Answer 31

a nulliparous 25-45 year old woman usually asymptomatic

Question 32

what are the symptoms associated with symptomizing fibroids ?

Answer 32

``` menstrual symptoms pressure symptoms pain infertility leucorrhea abdominal mass pregnancy complications general symptom od anemia ```

Question 33

what are the menstrual symptoms associated with symptomizing fibroids ?

Answer 33

menorrhagia metrorrhagia polymenorrhea

Question 34

what are the pressure symptoms associated with symptomizing fibroids ?

Answer 34

urinary frequency and incontinence loin pain due to ureteric compression pressure on pelvic veins causing LL oedema pressure on pelvic nerves

Question 35

when is pain associated with fibroids ?

Answer 35

painless until complicated

Question 36

what are the causes of infertility in fibroids ?

Answer 36

``` uncommon but interference with implantation tubal obstruction interference with ascent of sperm associated conditions ( salpingoophoritis ) ```

Question 37

what does a fibroid look like on clinical examination ?

Answer 37

central suprapubic mass firm in consistency moveable from one side to the other

Question 38

what are the indications to operate on a symptomless fibroid ?

Answer 38

no symptoms no treatment unless the patient is : pregnant more than 14 weeks pedunculated subserous fibroid or under any suspicion of malignancy

Question 39

when is medical treatment indicated ?

Answer 39

menorrhagia with a pregnant uterus less than 12 weeks | with the aim to control the menorrhagia

Question 40

what medications are used for the management of fibroids ?

Answer 40

``` progestins, danazol and anti-progesterone LHRH agonists ( leuprolide acetate) ```

Question 41

what is the definitive surgical management of fibroids ?

Answer 41

hysterectomy

Question 42

what is the non definitive surgical management of fibroids that can be used to maintain fertility ?

Answer 42

myomectomy

Question 43

what are the contraindications to a myomectomy ?

Answer 43

after menopause or in premenopausal women during pregnancy at CS suspicion of sarcomatous change

Question 44

when do we perform a vaginal myomectomy ?

Answer 44

in fibroid polyp

Question 45

what are the symptoms of cervical fibroids ?

Answer 45

they have no effect of menstrual function but may present with pressure symptoms

Question 46

what type of surgery can be used for a small myomata within the cavity ?

Answer 46

Hysteroscopic Myomectomy