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1、Uterine Myoma,Womens Hospital,School of Medicine Zhejiang University Prof.Lin Jun,Introduction,Most common benign tumor of female reproductive systemBenign neoplasm composed primarily of smooth muscleCommon in women 30-50yUsually asymptomatic,Etiology,Not detectable before puberty and after menopaus
2、e Probably relates to female hormonesEstrogen and ER Progestin may promote mitosis（有丝分裂）of myoma,Classification,According to the location：Uterine body myoma 90%Cervical myoma 10%,Classification,According to the relationship between myoma and uterine myometrium：intramural myoma 60%-70%subserous myoma
3、 20%submucous myoma 10%-15%,Classification,Classification,multiple myoma,Pathology,Gross Appearance：round,smooth,and usually firmfalse capsular covering pseudocapsule can be clearly demarcated from the surrounding myometrium,Pathology,Gross Appearance：Transverse section:light gray a whorl-like arran
4、gement or an intertwining pattern,Pathology,Microscopic examination：composed of smooth muscle cells and varying amounts of connectives tissueIndividual cells are quite uniform in size,spindle shaped,have elongated nuclei.Nonstriated muscle fibers（平滑肌纤维）are arranged in interlacing bundles of varying
5、size running in different directions.,Degeneration,Hyaline degenerationCystic degenerationRed degenerationSarcomatous changeDegeneration with calcification,Degeneration,Red degenerationmost common during pregnancy and puerperiumvenous thrombosis and congestion with interstitial hemorrhage,Degenerati
6、on,Red degeneration Hyaline degeneration,Degeneration,Sarcomatous change malignantrare,0.4-0.8%old womenenlarge rapidly with irregular vaginal bleeding,Degeneration,Sarcomatous change,Symptoms,Usually no symptomsAssociate with location,and degenerationsNot associate with the size and the number,Symp
7、toms,1.menorrhagia and prolonged menseslarge intramural myoma submucous myoma2.abdominal mass3.leukorrhagia,Symptoms,4.pressure effectspressure bladder or rectum urinary frequency,constipation（便秘）intraligamentous myoma and large cervical myoma obstruct ureter 5.othersinfertilityspontaneous abortiona
8、bdominal pain,Sign,associated with：sizelocationnumber degenerationlarge myoma palpable abdominal massPelvic examination：uterus enlarged，irregular and hard,Diagnosis,Typical symptoms and signsUltrasound HysteroscopyLaparoscopy,Ultrasound,Ultrasound,Diagnosis,Hysteroscopy,Diagnosis,Laparoscopy,Differe
9、ntial diagnosis,PregnancyOvarian neoplasmsAdenomyosisMalignant tumors of uterusuterine sarcomaendometrial carcinomacervical cancer,Treatment,According to:agedesire for childbearingsymptomslocation,size and amount of myoma,Treatment,Observation and Follow UpSmall，asymptomatic，especially near menopaus
10、eInterval：36 months,Medical measure,Indications：smaller than 2 months in sizeslight symptomsnear menopause,Medical measure,1.Androgenic agents（雄激素）：testosterone propionate（丙酸睾酮）2.Gonadotropin-releasing hormone agonist,（GnRH-a）,GnRH-a LH、FSH E2 shrinkage of myomaleuprorilin（亮丙瑞林）goserelin（戈舍瑞林）,Medic
11、al measure,2.GnRH-aSide effects:Hypoestrogenic side effectsOsteoporosis3.Mifepristone,Surgical measures,Indications：greater than 10 weeks in sizemenorrhagia anemiapressure effectsgrows rapidlyfailure in medical treatmentinfertility or recurrent abortion,Surgical measures,Myomectomypreserve fertility
12、,35 years old2.HysterectomyNumerous large tumors Obviously symptomatic patient No wish of preserving fertility Suspected to malignant transformation,Myomas during pregnancy,Impact on pregnancy：abortionImpact on delivery：preterm labor（早产）fetal malpresentation（胎位异常）placenta previa（前置胎盘）birth canal obstructionpostpartum hemorrhage（产后出血）,Myomas during pregnancy,Red degenerationClinical finding:pain,fever,WBCrapid growth of myoma，tendernessConservative treatment,Thank You!,
