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)
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.
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.
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.