2. References Robbins and Cotran: Pathophysiologic Basis of Disease. 7 th ed. 2005. Lethaby A, Fibroids (uterine myomatosis, leiomyomas). Am Fam Physician. 2005 May 1;71(9):1753-6. PMID: 15887454 Hart R. Unexplained infertility, endometriosis, and fibroids. BMJ. 2003 Sep 27;327(7417):721-4. PMID: 14512481 Aggarwal BK, Panwar S, Rajan S, Aggarwal A, Ahlawat K. Varied appearances & signal characteristics of leiomyomas on MR imaging. Indian J Radiol Imaging [serial online] 2005 [cited 2008 Jul 2];15:271-6. Degenerative Leiomyomas 65% of leiomyomas are degenerative Hyaline (>60% of cases) Cystic (~4%) Red Mucinous Fibrotic (typical change with age) Hence the term “fibroids” Also may see hemorrhage, necrosis, and calcification (~4% of cases) Edema is a common histopathologic finding (~50% of cases) Sarcomatous is controversial Unusual Leiomyomas Lipoleiomyoma Myxoid leiomyoma The “Dr. Chun Special” 2Cs, 2Hs, 2omatous, fatty C ystic C alcific H emorrhagic H yaline myx O matous sarc O matous F atty Uterine Leiomyoma with Degeneration • This is a solitary, ovoid leiomyoma which has been bisected. • The center is soft, brown and degenerated. • Arrow shows the rim of firm, white tissue typical of a leiomyoma. http://radiology.uchc.edu/eAtlas/GYN/153.htm Robbins: A , Leiomyomas of the myometrium. The uterus is opened to reveal the tumors bulging into the endometrial cavity and displaying a firm white appearance on sectioning. B , Leiomyoma showing well-differentiated, regular, spindle-shaped smooth muscle cells. Sharply circumscribed, discrete, round, firm, gray-white tumors varying in size Characteristic whorled pattern of smooth muscle tissue large leiomyoma with "red degeneration http://library.med.utah.edu/WebPath/FEMHTML/FEM029.html