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Benign lesion of the Uterus
What we learn today ……
1) Cause of enlargement of Uterus .
2) Type of Benign tumor of uterus .
3) Fibroid Uterus in all aspect.
4) Uterine polyp.
5) Endometrial hyperplasia.
Physiological: Pregnancy.
Pathological :
Sub mucous or intramural fibroid.
Adenomyosis.
Myohyperplasia .
Pyometra.
Haematometra.
Malignancy (Ca body of uterus , Choriocarcinoma , Sarcoma)
Benign tumour :
1.Leiomyoma (Most common)
Myoma.
Fibroma.
2.Benign endometrial polyps:
 Mucosal polyp.
 Endometrial hyperplasia.
Malignant tumour:
• Carcinoma of endometrium.
• Leiomyosarcoma .
• Endometrial stromal sarcoma.
Benign lesion of the uterus
Fibroid are common benign tumour of the myometrium composed of
smooth muscle & fibrous connective tissue .
Type to fibroid uterus / fibromyoma / leiomyoma :
1.Body : 98-99%
Interstitial ( intramural ,70%) : Those embedded within the myometrium.
Subserous (sub peritoneal) : Those occur beneath the covering serosa.
Submucous (about 5% ,less common) : Those occur beneath the
endometrium.
2.Cervical (1-2%): It is usually confined to the supra-vaginal part of cervix.
 Interstitial.
 Subserous.
https://youtu.be/FsixP9zwq-ohttps://youtu.be/FsixP9zwq-o
Benign lesion of the uterus
The uterus is enlarged.
Without capsule or pseudocapsule.
Whitish appearance.
The shape is distended by multiple nodular growth of varying sizes.
Firm is consistency .
Cut surface of the tumour is smooth & whitish.
Microscopic feature of liomyoma
Consist of smooth muscle & fibrous connective tissue of
varying proportion.
Originally , it consist of only muscle element but later on ,
fibrous tissue intermingles with muscle bundle.
Individual cells are well differentiated .
Profile :
 Usually nulliparous.
 Having long period of secondary infertility.
 Age: 30 – 40 year between or more.
Asymptomatic (75%)
Menstrual abnormality : Menorrhagia , metrorrhagia , dysmenorrhea.
Dyspareunia .
Infertility (30%)
Pressure symptoms : Constipation , dysuria , retention of urine .
Recurrence pregnancy loss : Miscarriage , Preterm labour.
Lower abdominal pain or pelvic pain.
Abdominal enlargement.
On general examination : Varying degree of pallor depending upon the
magnitude & duration of menstrual loss.
On abdominal examination : The tumour may not be sufficiently enlarged to
be felt per abdomen. But if enlargement to 12 weeks or more the following
feature are noted:
On palpation:
Fell is firm , more towards hard ; may be cystic in degeneration.
Margins are well defined except the lower pole which can’t be reached
suggestive of pelvic in origin.
Surface is nodular , may be uniformly enlarged in a single fibroid.
Mobility is restricted.
On percussion: The swelling is dull on percussion.
On pelvic examination: Bimanual examination reveals the uterus irregularly
enlarged by the swelling felt per abdominal.
Benign lesion of the uterus
USG.
Colour Doppler (TVS)
MRI.
Laparoscopy.
Hysteroscopy .
Uterine curettage.
Indication of myomectomy
Myoma causing infertility.
Myoma causing repeated abortion.
Persistent uterine bleeding despite medical therapy.
Excessive pain or pressure symptoms.
In fibroid size > 12 weeks, women desire to have baby.
Recurrent pregnancy wastage due to fibroid.
Rapidly growing myoma during during follow up.
Subserous pedunculated fibroid.
Torsion of subserous pedunculated fibroid.
Massive intra – peritoneal haemorrhage following rupture of
veins over serous fibroid.
Uncontrolled infected fibroid.
Uncontrolled bleeding fibroid.
Haemorrhage: Intracapsular & Intraperitoneal.
Degeneration.
Necrosis.
Infection.
Polycythemia due to Erythropoietic function by the
tumour.
What are the effect of fibroid on pregnancy
Infertility.
Abortion.
Premature labour.
Intrauterine growth retardation.
Malposition & Malpresentation.
Obstructed labour.
Follicular cyst of ovary.
Endometrial hyperplasia.
Endometrial carcinoma.
Endometriosis.
Increased surface area of the endometrium.
Endometrial hyperplasia due to hyperoestrinism.
Pelvic congestion.
Congestion & dilation of the subjacent endometrial venous
plexus caused by the obstruction of the tumour.
Ulceration of submucous fibroid & fibroid polyp.
Torn vessel from the sloughing base of polyp.
Associated endometrial carcinoma.
Cause of pain in lower abdomen in fibroid uterus
Due to tumour :
Degeneration.
Torsion subserous pedunculated fibroid.
Extrusion of polyp.
Associated pathology:
Endometriosis.
PID.
Treatment
Symptomatic fibroid
Medical treatment :
Antiprogesterone.
Danazol.
GnRH agonist.
Surgical:
Myomectomy.
Embolotherapy.
Myolysis.
Hysterectomy. > 40age & family complete.
Benign lesion of the uterus
Traits Fibroid Uterus Ovarian tumour
Growth Rate Very slowly ,takes year to
grow.
Slow, takes month to grow.
Menstrual Cycle
Menorrhagia.
Metrorrhagia.
Dysmenorrhoea.
Unaffected.
On palpation
1) Firm ,may be cystic in
degeneration.
2) Mobility is restricted
from above downwards
but can be moved from
side to side.
3) Internal examination:
Swelling is uterine.
4) Ascites not present.
1) Cystic ,tense cystic or
solid.
2) Freely mobile from all
direction.
3) Internal Examination :
Swelling is separated
from uterus.
4) Ascites may be present
in late cases.
Polyp is a clinical entity referring a tumour attached by a pedicle.
Types:
Benign
Adenoma.
Fibroid.
Placental.
Malignant:
Carcinoma.
Sarcoma, mixed mullarian tumour.
Choriocarcinoma.
Benign lesion of the uterus
Endometrial hyperplasia is a condition of excessive proliferation of the
cells of the endometrium, or inner lining of the uterus.
Fibroid Uterus Rubric from Murphy Repertory & Synthesis Repertory
1) Diseases - FIBROIDS, uterus.
2) Diseases - TUMORS, general – fibroid.
3) Female - FIBROIDS, uterus.
4) Female - BLEEDING, uterus, metrorrhagia - fibroids, from.
5) Female - TUMORS, genitalia - tumors, uterus.
6) Female - BURNING, pain, genitalia - burning, uterus - fibroids, with.
7) Female - TUMORS, genitalia.
8) FEMALE GENITALIA/SEX - TUMORS – Uterus.
9) FEMALE GENITALIA/SEX - METRORRHAGIA - fibroids, from.
10)FEMALE GENITALIA/SEX - MENSES - painful - myoma in uterus; from
hard and large.
Uterine Polyp Rubric from Murphy Repertory & Synthesis Repertory
1. Female - BLEEDING, uterus, metrorrhagia - polyps, from.
2. Female - POLYPS, genitalia.
3. Female - POLYPS, genitalia - polyps, cervix.
4. Female - POLYPS, genitalia - polyps, vagina.
5. FEMALE GENITALIA/SEX - METRORRHAGIA - accompanied by –
polyps.
6. FEMALE GENITALIA/SEX - METRORRHAGIA - polypus, from.
7. FEMALE GENITALIA/SEX – POLYPUS.
8. FEMALE GENITALIA/SEX - POLYPUS – Uterus.
Noman Ahmad
21/10/2020

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Benign lesion of the uterus

  • 1. Benign lesion of the Uterus What we learn today …… 1) Cause of enlargement of Uterus . 2) Type of Benign tumor of uterus . 3) Fibroid Uterus in all aspect. 4) Uterine polyp. 5) Endometrial hyperplasia.
  • 2. Physiological: Pregnancy. Pathological : Sub mucous or intramural fibroid. Adenomyosis. Myohyperplasia . Pyometra. Haematometra. Malignancy (Ca body of uterus , Choriocarcinoma , Sarcoma)
  • 3. Benign tumour : 1.Leiomyoma (Most common) Myoma. Fibroma. 2.Benign endometrial polyps:  Mucosal polyp.  Endometrial hyperplasia. Malignant tumour: • Carcinoma of endometrium. • Leiomyosarcoma . • Endometrial stromal sarcoma.
  • 5. Fibroid are common benign tumour of the myometrium composed of smooth muscle & fibrous connective tissue . Type to fibroid uterus / fibromyoma / leiomyoma : 1.Body : 98-99% Interstitial ( intramural ,70%) : Those embedded within the myometrium. Subserous (sub peritoneal) : Those occur beneath the covering serosa. Submucous (about 5% ,less common) : Those occur beneath the endometrium. 2.Cervical (1-2%): It is usually confined to the supra-vaginal part of cervix.  Interstitial.  Subserous.
  • 8. The uterus is enlarged. Without capsule or pseudocapsule. Whitish appearance. The shape is distended by multiple nodular growth of varying sizes. Firm is consistency . Cut surface of the tumour is smooth & whitish.
  • 9. Microscopic feature of liomyoma Consist of smooth muscle & fibrous connective tissue of varying proportion. Originally , it consist of only muscle element but later on , fibrous tissue intermingles with muscle bundle. Individual cells are well differentiated .
  • 10. Profile :  Usually nulliparous.  Having long period of secondary infertility.  Age: 30 – 40 year between or more.
  • 11. Asymptomatic (75%) Menstrual abnormality : Menorrhagia , metrorrhagia , dysmenorrhea. Dyspareunia . Infertility (30%) Pressure symptoms : Constipation , dysuria , retention of urine . Recurrence pregnancy loss : Miscarriage , Preterm labour. Lower abdominal pain or pelvic pain. Abdominal enlargement.
  • 12. On general examination : Varying degree of pallor depending upon the magnitude & duration of menstrual loss. On abdominal examination : The tumour may not be sufficiently enlarged to be felt per abdomen. But if enlargement to 12 weeks or more the following feature are noted: On palpation: Fell is firm , more towards hard ; may be cystic in degeneration. Margins are well defined except the lower pole which can’t be reached suggestive of pelvic in origin. Surface is nodular , may be uniformly enlarged in a single fibroid. Mobility is restricted. On percussion: The swelling is dull on percussion. On pelvic examination: Bimanual examination reveals the uterus irregularly enlarged by the swelling felt per abdominal.
  • 15. Indication of myomectomy Myoma causing infertility. Myoma causing repeated abortion. Persistent uterine bleeding despite medical therapy. Excessive pain or pressure symptoms. In fibroid size > 12 weeks, women desire to have baby. Recurrent pregnancy wastage due to fibroid. Rapidly growing myoma during during follow up. Subserous pedunculated fibroid.
  • 16. Torsion of subserous pedunculated fibroid. Massive intra – peritoneal haemorrhage following rupture of veins over serous fibroid. Uncontrolled infected fibroid. Uncontrolled bleeding fibroid.
  • 17. Haemorrhage: Intracapsular & Intraperitoneal. Degeneration. Necrosis. Infection. Polycythemia due to Erythropoietic function by the tumour.
  • 18. What are the effect of fibroid on pregnancy Infertility. Abortion. Premature labour. Intrauterine growth retardation. Malposition & Malpresentation. Obstructed labour.
  • 19. Follicular cyst of ovary. Endometrial hyperplasia. Endometrial carcinoma. Endometriosis.
  • 20. Increased surface area of the endometrium. Endometrial hyperplasia due to hyperoestrinism. Pelvic congestion. Congestion & dilation of the subjacent endometrial venous plexus caused by the obstruction of the tumour.
  • 21. Ulceration of submucous fibroid & fibroid polyp. Torn vessel from the sloughing base of polyp. Associated endometrial carcinoma.
  • 22. Cause of pain in lower abdomen in fibroid uterus Due to tumour : Degeneration. Torsion subserous pedunculated fibroid. Extrusion of polyp. Associated pathology: Endometriosis. PID.
  • 23. Treatment Symptomatic fibroid Medical treatment : Antiprogesterone. Danazol. GnRH agonist. Surgical: Myomectomy. Embolotherapy. Myolysis. Hysterectomy. > 40age & family complete.
  • 25. Traits Fibroid Uterus Ovarian tumour Growth Rate Very slowly ,takes year to grow. Slow, takes month to grow. Menstrual Cycle Menorrhagia. Metrorrhagia. Dysmenorrhoea. Unaffected. On palpation 1) Firm ,may be cystic in degeneration. 2) Mobility is restricted from above downwards but can be moved from side to side. 3) Internal examination: Swelling is uterine. 4) Ascites not present. 1) Cystic ,tense cystic or solid. 2) Freely mobile from all direction. 3) Internal Examination : Swelling is separated from uterus. 4) Ascites may be present in late cases.
  • 26. Polyp is a clinical entity referring a tumour attached by a pedicle. Types: Benign Adenoma. Fibroid. Placental. Malignant: Carcinoma. Sarcoma, mixed mullarian tumour. Choriocarcinoma.
  • 28. Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus.
  • 29. Fibroid Uterus Rubric from Murphy Repertory & Synthesis Repertory 1) Diseases - FIBROIDS, uterus. 2) Diseases - TUMORS, general – fibroid. 3) Female - FIBROIDS, uterus. 4) Female - BLEEDING, uterus, metrorrhagia - fibroids, from. 5) Female - TUMORS, genitalia - tumors, uterus. 6) Female - BURNING, pain, genitalia - burning, uterus - fibroids, with. 7) Female - TUMORS, genitalia. 8) FEMALE GENITALIA/SEX - TUMORS – Uterus. 9) FEMALE GENITALIA/SEX - METRORRHAGIA - fibroids, from. 10)FEMALE GENITALIA/SEX - MENSES - painful - myoma in uterus; from hard and large.
  • 30. Uterine Polyp Rubric from Murphy Repertory & Synthesis Repertory 1. Female - BLEEDING, uterus, metrorrhagia - polyps, from. 2. Female - POLYPS, genitalia. 3. Female - POLYPS, genitalia - polyps, cervix. 4. Female - POLYPS, genitalia - polyps, vagina. 5. FEMALE GENITALIA/SEX - METRORRHAGIA - accompanied by – polyps. 6. FEMALE GENITALIA/SEX - METRORRHAGIA - polypus, from. 7. FEMALE GENITALIA/SEX – POLYPUS. 8. FEMALE GENITALIA/SEX - POLYPUS – Uterus.