Fibroids

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Introduction

Also known as leiomyomata, fibroids are the most common gynecological tumour.

They occur in approximately half of women >35years, though decrease following menopause. They are more common in black women.

Fibroids rarely become malignant (0.1% of cases).

 

 

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.

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Causes and Risk Factors

 

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Pathophysiology

Fibroids are monoclonal, arising from single smooth muscle cells.

Apoptosis is decreased.

 

Growth in enhanced via progesterone. Estrogen appears to play minimal role.

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Signs and Symptoms

  • history
  • physical exam

History

Over half of fibroids are asymptomatic and are discovered incidentally on ultrasound.

  • abnormal uterine bleeding (dysmenorrhea or menorrhagia) in 30%
  • pelvic pressure
  • increased abdominal girth
  • urinary frequency, urgency, retention
  • constipation
  • bloating

Fibroid degeneration or torsion can lead to acute pelvic pain

Infertility

Physical Exam

Bimanual exam can reveal asymmetrically enlarged, mobile uterus

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

CBC (anemia)

endometrial biopsy recommended to rule out endometrial cancer

Diagnostic Imaging

  • Sonohystogram
  • saline infusion hystography

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Differential Diagnosis

 

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Treatments

Treat only if symptomatic or if rapidly growing.

Treat anemia if present.

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Consequences and Course

 

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Resources and References

 

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Topic Development

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