Leiomyoma

(UTERUS FIBROID)
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 ▪ Leiomyoma is a benign tumor of smooth muscle origin.
▪ It is the most common neoplasm of the female genital tract
and probably the most common neoplasm in women.
▪ The tumor is estrogen responsive and often increases in size
during pregnancy and decreases in size during menopause.
▪ Estrogens and possibly oral contraceptives stimulate their
growth; they shrink postmenopausally.
▪ About 40% of leiomyomas have an associated chromosomal
abnormality.
▪ This is a benign tumor with no appreciable malignant
potential (incidence of malignant transformation to
Leiomyosarcoma is 0.1-0.5%).

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 There are three primary types of uterine fibroids, classified
primarily according to location in the uterus:

These fibroids develop in the

Subserosal uterine outer portion of the uterus and
fibroids continue to grow outward

The most common type

of fibroid. These develop
Intramural uterine within the uterine wall and
fibroids expand making the uterus feel
larger than normal (which may
cause "bulk symptoms)
These fibroids develop just
under the lining of the uterine
cavity. These are the fibroids
Submucosal uterine that have the most effect on
fibroids heavy menstrual bleeding and
the ones that can cause
problems with infertility and
miscarriage

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Malignancy and Hyoerplasia

ENDOMETRIAL
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Hiperplasia endometrium
merupakan diagnosis
histologi, yang ditandai
dengan proliferasi kelenjar
endometrium sehingga rasio
kelenjar-stroma lebih besar
dibanding endometrium yang
normal.

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 Etiologi
▪ Pajanan estrogen yang terus menerus tanpa
diikuti dengan pajanan progesteron terhadap
endometrium, dapat menyebabkan terjadinya
hiperplasia endometrium.

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 Epidemiologi
▪ Milder forms of hyperplasia tends to occur in
younger patients.
▪ The great majority of mild hyperplasia regress,
either spontaneously or after treatment.
▪ The more severe forms, occur predominantly in
peri and postmenopausal women. This form
has a significant premalignant potential.

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 Klasifikasi menurut WHO

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 Manifestasi Klinis
▪ The most common sign of hyperplasia is abnormal
uterine bleeding. If you have any of the following,
you should see your health care provider:
▪ Bleeding during the menstrual period that is
heavier or lasts longer than usual
▪ Menstrual cycles that are shorter than 21
days (counting from the first day of the
menstrual period to the first day of the next
menstrual period)
▪ Any bleeding after menopause
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 Diagnosis
▪ There are many causes of abnormal uterine bleeding. If you have abnormal
bleeding and you are 35 years or older, or if you are younger than 35 years and
your abnormal bleeding has not been helped by medication, your health care
provider may perform diagnostic tests for endometrial hyperplasia and cancer.
▪ Transvaginal ultrasound may be done to measure the thickness of the
endometrium. For this test, a small device is placed in your vagina. Sound
waves from the device are converted into images of the pelvic organs. If the
endometrium is thick, it may mean that endometrial hyperplasia is present.
▪ The only way to tell for certain that cancer is present is to take a small sample of
tissue from the endometrium and study it under a microscope. This can be done
with an endometrial biopsy, dilation and curettage, or hysteroscopy.

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 Tatalaksana
▪ In many cases, endometrial hyperplasia can be treated with
progestin. Progestin is given orally, in a shot, in an intrauterine
device, or as a vaginal cream. How much and how long you take
it depends on your age and the type of hyperplasia. Treatment
with progestin may cause vaginal bleeding like a menstrual
period.
▪ If you have atypical hyperplasia, especially complex atypical
hyperplasia, the risk of cancer is increased. Hysterectomy
usually is the best treatment option if you do not want to have
any more children.

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 ThIs too shall pass.
It mIght pass lIke a kIDney stone BUT It wIll past.
Hang In there.

Goodluck 2016!

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