Uterine Leiomyomas

Question 1

MC pelvic tumor in women

Answer 1

leiomyoma aka fibroids

Question 2

leiomyoma

Answer 2

smooth muscle pelvic tumor

benign in myometrium

Question 3

epidemiology of leiomyoma

Answer 3

30-40 y.o

AA younger

2-3x more common in AA women

Question 4

risk factors of leiomyoma

Answer 4

early menarche** (<10)

DES tx, obesity, fHTN

Question 5

protective factors of leiomyoma

Answer 5

parity (20+ weeks)

long acting progestin only contraception

smoking

Question 6

fibroids and reproductive hormones

Answer 6

nonexistent in pre puberty, found in reproductive age , and regress after menopause

Question 7

intramural myxomas

Answer 7

developing within uterine wall

Question 8

submucosal myomas

Answer 8

derive from myometrial cells

below endometrium

protrurde into uterine cavity

Question 9

subserosal myomas

Answer 9

OG at myometrium at SEROSAL surface of uterus

extend OUTWARD

Question 10

cervical myoma

Answer 10

located in cervix

rare

Question 11

clinical presentation

Answer 11

1. heavy/prolonged menstrual bleeding
2. pelvic pressure and pain
3. reproductive dysfunction

Question 12

heavy bleeding in CP

Answer 12

can cause IDA, increased PMS symptoms

this is NOT intermenstrual and post menopausal

heavy, PROLONGED, menarche (nml)

Question 13

menorrhagia is most associated with

Answer 13

submucosal fibroids that protrude into uterine wall (O and I)

Question 14

type 0 submucosal

Answer 14

not located within uterine wall

Question 15

type I submucosal

Answer 15

<50% invasion of uterine wall

Question 16

type II submucosal

Answer 16

> 50% invasion of uterine wall

Question 17

degeneration of fibroid

Answer 17

fibroid gets so large that blood supply is inefficient so it undergoes necrosis

should be on DDX

low fever, leukocytosis, peritoneal signs

Question 18

bimanual exam findings fibroid

Answer 18

enlarged, mobile uterus w/irregular contour and firmness

Question 19

evaluation fibroid

Answer 19

1. hCG + TVUS
2. hystroscopy
3. MRI

Question 20

necrosed fibroid US looks like?

Answer 20

calcifications with posterior shadowing

Question 21

TVUS of fibroid

Answer 21

initial tool for eval

whorled appearance + hypoechoic

Question 22

reproductive dysfunction fibroid

Answer 22

difficulty conceiving, increased miscarriage

placental abruption, IUGR, malpresentation, pre term labor risk

Question 23

tx of fibroid

Answer 23

relief of symptoms and prevention of complications

typically not removed

Question 24

medication management leiomyoma

Answer 24

NSAIDs (decrease cramping)

combo OC (decreased bleeding, not size)

progestin only pills (increase size, decrease bleeding)

GnRH agonist (debulking, bridge to sx)

iron replacement

Question 25

asymptomatic fibroids tx

Answer 25

watchful waiting

Question 26

postmenopausal fibroid tx

Answer 26

typically shrink and stop symptoms no tx

Question 27

when to consider sx of leiomomya

Answer 27

desires fertility complications arise declines to take medicine symptoms progress.fail to improve

Question 28

surgical options if pt does NOT desire fertility

Answer 28

hysterectomy MRgFUS

Question 29

surgical tx if pt DOES desire fertility

Answer 29

hystroscopy (submucosal) intramural or subserosal - abdominal myomectomy (increased risk fo uterine rupture) myolysis UAE

Question 30

uterine artery embolisation

Answer 30

IR, not optimal for preserving fertility endometritis and PES risl

Question 31

PES

Answer 31

acute pain, fever, malaise, n/v, night sweats following UAE sx resolves by 48 hrs

Question 32

leiomyosarcoma

Answer 32

smooth muscle malignant neoplasm ss as myxomas but post menopausal bleeding MC 60 y.o., AA women

Question 33

BBW due to risk of leiomyosarcoma

Answer 33

tamoxifen

Question 34

adenomyosis

Answer 34

glands in muscle endometrial glands and storm present in uterine musculature

Question 35

adenomyosis

Answer 35

hypertrophy and hyperplasia in myometrium uterus becomes enlarged (same as prego 12 weeks) MC in porous

Question 36

symptoms of adenomyosis

Answer 36

heavy menstrual bleeding (AUB) painful menstruation pelvic fullness, chronic pelvic pain NO indication increased risk of miscarriage/OB outcome

Question 37

PE adenomyosis

Answer 37

uterus TTP enlarged and boggy uterus (diffuse)

Question 38

adenomyosis w.u.

Answer 38

TVUS = TOC

Question 39

diagnostic criteria on MRI of adenomyosis

Answer 39

asymmetric thickening (> 12 mm) if <8mm = excluded

Question 40

definitive dx of adenomyosis

Answer 40

histology of hysterectomy presence of endometrial tissue within myometrium

Question 41

definitive tx of adenomyosis

Answer 41

hysterectomy if completed childbearing