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    Fibroids: 1. Red Degeneration

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    cgao30
    Fibroids are benign smooth muscle tumors of the uterus that occur in around 20-50% of women over age 30. They can undergo degeneration over time through processes like red degeneration which causes hemorrhaging, or hyaline and myxoid degeneration which involve fibrosis or cyst formation within the tumor. Fibroids often do not cause symptoms but can sometimes lead to heavy bleeding, pelvic pressure, pain, or infertility. Diagnosis involves ultrasound, hysteroscopy or MRI, and treatment options range from observation of asymptomatic fibroids to surgical procedures like myomectomy or hysterectomy depending on the severity of symptoms.

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    Fibroids: 1. Red Degeneration

    Uploaded by

    cgao30
    57 views2 pages
    Fibroids are benign smooth muscle tumors of the uterus that occur in around 20-50% of women over age 30. They can undergo degeneration over time through processes like red degeneration which causes hemorrhaging, or hyaline and myxoid degeneration which involve fibrosis or cyst formation within the tumor. Fibroids often do not cause symptoms but can sometimes lead to heavy bleeding, pelvic pressure, pain, or infertility. Diagnosis involves ultrasound, hysteroscopy or MRI, and treatment options range from observation of asymptomatic fibroids to surgical procedures like myomectomy or hysterectomy depending on the severity of symptoms.

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    Fibroids matrix

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    Fibroids

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    Fibroids are benign smooth muscle tumors of the uterus that occur in around 20-50% of women over age 30. They can undergo degeneration over time through processes like red degeneration which causes hemorrhaging, or hyaline and myxoid degeneration which involve fibrosis or cyst formation within the tumor. Fibroids often do not cause symptoms but can sometimes lead to heavy bleeding, pelvic pressure, pain, or infertility. Diagnosis involves ultrasound, hysteroscopy or MRI, and treatment options range from observation of asymptomatic fibroids to surgical procedures like myomectomy or hysterectomy depending on the severity of symptoms.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    57 views2 pages

    Fibroids: 1. Red Degeneration

    Uploaded by

    cgao30
    Fibroids are benign smooth muscle tumors of the uterus that occur in around 20-50% of women over age 30. They can undergo degeneration over time through processes like red degeneration which causes hemorrhaging, or hyaline and myxoid degeneration which involve fibrosis or cyst formation within the tumor. Fibroids often do not cause symptoms but can sometimes lead to heavy bleeding, pelvic pressure, pain, or infertility. Diagnosis involves ultrasound, hysteroscopy or MRI, and treatment options range from observation of asymptomatic fibroids to surgical procedures like myomectomy or hysterectomy depending on the severity of symptoms.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Degeneration

    Fibroids Fibroids may undergo atrophy, internal haemorrhage,


    Definition fibrosis and calcification.
    Benign tumours of the uterus primarily composed of Types of degeneration:
    smooth muscle & fibroids connective tissue
    leiomyomata (monoclonal). 1. Red degeneration**
    Presents with acute abdo pain
    Epidemiology Risk factors
    Occurs in 20 50% of women >30y.o. o Pregnancy
    Most common solid tumour of the female o PCOS
    pelvis o Hormone supplement (e.g. OCP, HRT)
    In ~85% of cases, fibroids occur in multiples Due to haemorrhagic infarction

    Risk factors/Aetiology 2. Hyaline degeneration (~60%)


    Focal or generalised hyalinisation
    BMI
    Advanced maternal age
    3. Cystic degeneration (~5%)
    Black ethnicity
    Fibroid outgrows vascular supply oedema
    Exposure to sex hormones (e.g. contraceptive,
    HRT)
    4. Myxoid degeneration
    Hypertension
    Filled with gelatinous material
    High intake of beef/red meat
    Appear as complex cystic masses
    Smoking
    Can mimic malignant leiomyosarcoma
    Pathophysiology
    Signs & symptoms
    Arise from the myometrial layer of the uterine
    Commonly asymptomatic
    corpus (intramural)
    Irregular firm, central pelvic mass
    o Protrudes outward = subserosal
    o Protrudes inward = submucous O&G
    Symptoms associated with distortion of
    endometrial lining more common in Abnormal PV bleed (due to distortion of
    submucous endometrial lining most common with
    Growth accelerates during pregnancy (due to submucous fibroids)
    elevated hormones) Heavy periods (menorrhagia)
    Involutes at menopause Infertility
    Dyspareunia (if on cervix)
    Classification
    Space-occupying
    1. Intra-uterine
    o Subserosal Recurrent 2nd trimester loss
    o Intramural (most common) Obstructed labour
    o Submucosal (least common) Dysmenorrhoea (obstruction of menstrual
    flow)
    2. Extra-uterine
    Pressure:
    o Cervical within the cervix
    o Broad ligament located between 2 Bloating
    layers of the ligament Pelvic pressure
    o Parasitic (likely pedunculated Urinary frequency/urgency
    subserosal leiomyoma that twists off Urinary & faecal incontinence
    and latches on to adjacent structures, Pedunculated submucous fibroids can dilate
    with neo-vascularisation) cervix prolapse into vagina risk of
    infection
    3. Diffuse uterine leiomyomatosis
    Pain: Complication

    Acute or chronic pain 2 degeneration Recurrent uterine fibroid growth


    Menorrhagia Labour & delivery complications
    Dysmenorrhoea Acute torsion
    Significant haemorrhage
    Bleed:
    Anaemia
    Abnormal PV bleed Degenerative changes

    Diagnosis

    Test Findings
    Abdominal Heterogenous hypoechoic masses
    U/S 1st line +/- cystic areas
    Hysteroscopy Direct visualisation of space-
    occupying lesions
    Laparoscopy + Visualisation of irregular
    histology protrusion from uterine
    gold standard surface

    MRI For evaluation of atypical cases of


    pelvic/abdo masses

    Gross pathology: firm, round, well-


    circumscribed nodules located either:
    o Subserosal (under the uterine serosa)
    o Intramural (within myometrium)
    o Submucosal (just below the
    endometrium)

    Micropathology: spindle-shaped cells with no


    mitotic activity or remarkable nuclear atypia

    Management

    Conservative: if fibroids are asymptomatic and not


    causing any complications, simply monitor for any
    changes

    Medical (pre-operative adjunct)

    Mifepristone
    Mirena

    Surgical

    1st line: myomectomy

    The only surgical procedure that preserves


    fertility
    Complications
    o Recurrence
    o Haemorrhage

    Alternative: UAE (uterine artery embolization)

    Definitive: Hysterectomy

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