Uterine Leomyomata

Question 0

Exam findings consistent with uterine fibroids? Consistent with ovarian mass?

Answer 0

Irregular midline mass continuous with the cervix

Lateral mass apart from the cervix

Question 1

Most common reason for hysterectomy in the US? Most common symptom? Hysterectomy performed in which patients?

Answer 1

Symptomatic uterine fibroids; menorrhagia;

Systematic fibroids that are refractory to medical therapy

Question 2

Patient with menorrhagia - consider?

Metrorrhagia?

Answer 2

Fibroids

Endometrial hyperplasia, endometrial polyp, uterine cancer, uterine fibroids

Question 3

Type of fibroid that impinges on Uterine cavity?

Answer 3

Submucosal

Question 4

Types of fibroids?

Answer 4

1. Subserosal
2. Intramural
3. Sub mucosal
4. Pedunculated
5. Cervical
6. Prolapsed

Question 5

Carneous degeneration? aka?

Answer 5

Changes of the fibroid due to rapid growth – Center becomes a red and causes pain

Red degeneration

Question 6

Signs of a leiomyosarcoma? Risk factor?

Answer 6

Rapid growth (increase of more than six weeks gestational size in one year)

Radiation the pelvis

Question 7

Signs of prolapsed fibroid?

Answer 7

Labor-like contractions and pain

Question 8

Differential diagnosis for fibroids?

Answer 8

1. Ovarian masses
2. Tubo-ovarian masses
3. Pelvic kidney
4. Endometrioma

Question 9

Initial treatment for fibroids?

Other tx?

Answer 9

NSAIDs or progestin

1. GnRH agonist
2. Hysterectomy if future pregnancy undesired
3. Myomectomy if future pregnancy desired
4. Uterine artery embolization

Question 10

GnRH agonist – used for? Time course? downside? Use when?

Answer 10

GnRH agonist (take three months but after cessation, fibroids will regrow)

Tumor shrinkage or correction of anemia prior to operative treatment

Question 11

Uterine artery embolization?

Answer 11

Cannulizing femoral artery and infusing embolization particles into uterine arteries (to float into fibroid vessels) leading to fibroid infarction

Question 12

Type of fibroids associated with recurrent abortion? Why?

Answer 12

Submucosal – altered endometrium, and insufficient vasculature

Question 13

Fibroids may present with severe pain if?

Answer 13

Twists on pedicle

Question 14

Patient with myomectomy gets pregnant – concern?

Answer 14

Uterine rupture – delivered via C-section

Question 15

Progestins and GnRH agonists stop being effective for fibroids when?

Answer 15

When Leiomyomas degenerate into leiomyosarcomas