Myoma.

Front 1

synonyms of myoma

Back 1

fibroid.
leiomyoma.
fibromyoma.
fibroma.

Front 2

myoma is benign or malignant?

Back 2

b9

Myoma is a kind of mesenchymal tumor.
Mesenchyme, or mesenchymal connective tissue, is a type of undifferentiated loose connective tissue

Front 3

content of myoma.

Back 3

smooth muscle.
fibrous connective tissue.

Front 4

epidemiology of myoma.

Back 4

occur in 20-40% of reproductive-aged women

high incidence in black women.

more common in nulliparous.

prevalence year:35-45 yo

regress incidence in menopouse women.

increases with age, decreases with having a live-born child.

may increase with body mass index, and may decrease with cigarette smoking.

Risk may also increase with diets high in red meat and ham and it may decrease with diets high in intake of green vegetables.

Front 5

increasing RF factor.

Back 5

nulliparity
obesity
hyper-estrogenic state
black women
red meat rich diet

Front 6

definition of nulliparity.

Back 6

the condition in a woman of never having given birth.

Front 7

reducing RF factor.

Back 7

smoking
multiparity
diet rich in green vege

Front 8

origin of myoma. pathogenesis.

Back 8

it arise from neoplastic single smooth muscle cell of myometrium.

stimuli of neoplastic transformation:
~chromosomal abnormality

~role of polypeptide growth factor.
Epidermal growth factor (EGF)
Insulin like growth factor-1 (IGF-1)
tranSforming growth factor (TGF)
*this hormones stimulate the growth of myoma either Directly or via Estrogen.

positive family history is often present.

Front 9

estrogen dependent growth evidence.

Back 9

increased growth during pregnancy.

do not occur before menarche.

growth is potentially limited during childbearing.

they content more estrogen
receptors compared to adjacent
myometrium.

cessation during menopouse.

frequently associated with anovulation.

Front 10

definition of childbearing.

Back 10

parturition. process of giving birth.

Front 11

myoma and menopouse.

Back 11

myoma growth is a result of the stimulation of estrogen, which is present until menopause.

Conversely, many myomas begin to shrink as menopause removes the estrogen stimulation and many myoma-related symptoms resolve spontaneously shortly after menopause.

Front 12

gross appearance of myoma.

Back 12

greyish

Front 13

type of myoma.

Back 13

body (at body of uterus)
~aka corporeal myoma
~submucous, intramural, subserous, pedunculated.

cervical
~upon position: anterior, lateral, posterior, central.

Front 14

pseudocervical fibroid.

Back 14

this is SUBMUCOUS fibroid arising from uterine body and burrow downwards into cervix canal.

Front 15

types of cervical myoma.

Back 15

anterior myoma.
tumor arise from superficial muscle of the anterior lip of cervix bulge forward and weaken the bladder.

posterior
arise at posterior part of cervix and cause flattening of douglas pouch backwards (compression rectum against sacrum), weakenin of peritoneum in bottom of douglas pouch and obliterate cul-de-sac, lift the serous membrane off the anterior surface of the rectum and sacrum and push down between vagina and rectum, separating waldeyer's fascia.

lateral
myoma burrows into broad ligament and expand it.

central.
either submucous or interstitial(intramural), expanding the cervix in all directions.

Front 16

where is the location of douglas pouch?

Back 16

between rectum and back wall of uterus. it is the continuity of peritoneal cavity.

Front 17

what is wandering or parasitic fibroid?

Back 17

the pedunculated subserous fibroid in which its stalk is thorn from the uterus and the fibroid gets nourishment from omental or mesenteric adhesion.

Front 18

most dangerous type of myoma.

Back 18

submucous.

Front 19

fate of submucous myoma.

Back 19

surface necrosis.
polypoid change.
infection.
degeneration including sarcomatous change.

Front 20

corporeal myoma.
gross appearance.

Back 20

uterus is enlarged.
distorted shape: can be nodular.
firm.
surface is smooth, whitish color.

cut surfaced: whorled and trabeculation.
(due to intermingling of fibrous tissue with muscle bundles)

false capsule.
it is formed by the compressed adjacent myometrium.
capsule separated from the growth by thin loose areolar tissue (blood supply runs through this plane)

peripheral part is more vascular compared central part n most likely to degenerate.

Front 21

blood supply of myoma usually comes from which artery?

Back 21

uterine artery.

Front 22

secondary changes in fibroid.

Back 22

degeneration
atrophy
necrosis
infection
vascular changes
sarcomatous changes

Front 23

types of degeneration in fibroid.

Back 23

Hyaline degeneration
cystic degeneration
fatty degeneration
calcerous degeneration
red degeneration

Front 24

most common degeneration type in fibroid.

Back 24

hyaline degeneration

Front 25

what happen in fatty degeneration of fibroid?

Back 25

fat globules deposited (mainly in muscle cells).

revise composition of fibroid.

fatty degeneration usually occur at or after menopouse.

Front 26

what happen in calcerous degeneration?

Back 26

precipitation of calcium carbonate or phosphate whithin the tumor.

usually involve subserous fibroid.
usually preceded by fatty degeneration.

if the whole of tumor is calcified, it is called 'womb-stone'

Front 27

what happen in hyaline degeneration?

Back 27

microscopic examination shows hyaline changes of both muscle and fibrous tissues.

in cut surface: irregular homogenous area with loss of whorl-like appearance.

hyaline degeneration commonly takes place at:
at all size tumore except tiny one.
tumor having more connective tissue.

Front 28

where is the common site of hyaline degeneration?

Back 28

central part of tumor where least vascular.

*tumor become elastic (no longer firm)

Front 29

what happen in cyctic degeneration?

Back 29

liquefaction of tumor with hyaline changes.

cystic space are lined by irregular ragged walls.

common in interstitial fibroids.

can be minstaken with ovarian cyst or pregnancy

Front 30

what happen in red degeneration?

Back 30

naked eye appearance: dark area (due to presence of haemolysed rbc and hemoglobin)

cut section: raw-beef appearance often containing cystic spaces.

odor often fishy due to fatty acid.

microscopic: evidence of necrosis
vessels are thrombosed

Front 31

red degeneration aka?

Back 31

carneous degeneration.

Front 32

when usually carneus degeneration takes place?

Back 32

during second trimester and puerperium.

usually occur in large fibroid.

Front 33

what is common sarcomatous change in fibroid case?

Back 33

leiomyosarcoma.

Front 34

what vascular changes may occur in myoma?

Back 34

telangiectasia,

lymphangiectasia.

Front 35

what cause atrophy changes in fibroid?

Back 35

decrease estrogen level.

thats y atrophy changes usually occur after menopouse.

Front 36

in what case necrosis of myoma takes place?

Back 36

inadequacy of circulatory.

Front 37

which part of fibroid most like to undergo necrosis first? and why

Back 37

central part, due to lack of vascularity

Front 38

infection of fibroid occur in which type of myoma mostly? how.

Back 38

submucous.

infection rise from thin/sloughed off epithelium surface

usually occur following delivery and abortion or any medical manipulation.

Front 39

complication of fibroid.

Back 39

degeneration
necrosis
infection
sarcomatous changes
torsion of pedunculated fibroid
hemorrhage
polycythemia

Front 40

symptoms of myoma mostly related to?

Back 40

size.
anatomic type.

Front 41

what is myomatous-erythrocytosis syndrome?

Back 41

triad of myomatous uterus, erythrocytosis, and restoration and maintenance of normal hematologic values after hysterectomy.

Front 42

what are the main presentation of myoma?

Back 42

pain
pressure symptoms
swelling/lumps
menstrual abnormalities
infertility
dysmenorrhea,dyspareunia
pregnancy related problem

NB! 75% are Asymptomatic

Front 43

describe characters of pain in myoma.

Back 43

fibroids are mostly painless.
maybe due to its slow growth hence the mass effect is tolerable by patient.

Acute pain may occur in such case:
degeneration(infarct) of the tumor.
torsion of the fibroid.
extrusion of polyp.

asscociated pathology which can cause painful event:
PID
endometriosis

Front 44

how myoma may cause infertility?

Back 44

uterine:
distortion/elongation of uterine cavity-> difficult sperm ascend

impairment of rythmical uterine contraction due to fibroid during intercourse->impaired sperms transport.

congestion and dilatation of endometrial venous plexus->defective nidation.

atrophy and ulceration of the endometrium over the submucous fibroid->defective nidation.

Tubal:
cornual block due to position of the fibroid.
associated salpingitis with tubal block.

Ovarian.
anovulation

peritoneal
endometriosis

Front 45

how can myoma affect pregnancy?

Back 45

PROBLEM:
abortion.
preterm labor.
intrauterine growth restriction.

REASON:
defective implantation of placenta
poorly developed endometrium
reduce space of growing

Front 46

enumerate life-threatening complications of fibroid.

Back 46

persistent menorrhagia, metrorrhagia or continued vaginal bleeding -> severe anemia

sarcoma

severe infection leading to peritonitis or septicemia

severe intraperitoneal haemorrhage due to rupture of veins over subserous fibroid.

Front 47

what are the symptoms in cervical myoma?

Back 47

anterior:
bladder symptom like frequency, retention of urine

Posterior:
rectal symptom in the form of constipation

lateral:
vascular obstruction may lead to hemmorhoid and leg edema

central
bladder symptom.
cervix expanded at all side, lantern on the dome of st paul condition.

Front 48

list the examination method in myoma.

Back 48

abdominal examination
pelvic examination

instrumental examination:
U/S and Color Doppler
MRI
Laparascopy
Hysteroscopy
Uterine curettage

Front 49

result of abdominal palpation in case of myoma?

Back 49

firm
margin is well defined
nodular surface
restrictive mobility from above downward, but can move side to side.

Front 50

what are u/s and color doppler finding in myoma?

Back 50

~ uterine contour is enlarged and distorted

~fibroids appear as different echogenicity-hypoechoic or hyperechoic (depending on amount of connective tissue or smooth muscle proliferation)

~vascularization at periphery site

~central vascularization indicate degenerative changes.

Front 51

hysteroscopy method is best to check which type of fibroid?

Back 51

submucous

Front 52

what can u see in hysterosalpingography in presence of fibroid?

Back 52

filling defect.

Front 53

what are differential diagnosis of fibroid?

Back 53

~pregnancy
~ full bladder
~ adenomyosis
~ myohyperplasia
~ovarian tumor
~ endometriosis
~ inflammatory mass

Front 54

what are w anatomical parts of cervix?

Back 54

vaginal part and supra-vaginal part

Front 55

what are 2 ways of performing u/s in myoma evaluation?

Back 55

trans-abdominal.
trans-vaginal.

Front 56

what complications may arise during pregnancy with myoma?

Back 56

preterm labor

red degeneration occur more frequently

difficulty in vaginal birth

inteference with pregnancy and its maintenance

clinical contracted pelvis.

Front 57

drugs used in medical treatment for fibroma are?

Back 57

NSAID (ibuprofen)
to relieve pelvic pain.

GnRH agonist
~ gosereline, luporelin, burseveline, nafaseline.
~MOA: supress anterior pituitary from producing estrogen.
~often used in pre-surgical therapy to shrink the tumor.

Danazol
~gonadotropin inhibitor. and has androgenic effect
~minimize blood loss and can be used in range 3-6 months

Front 58

which drugs used to minimize the bleeding?

Back 58

progestogene.

antifibrinolytic.

anti progesterone.

danazol.

prostaglandin synthethase inhibtor.

GnRH analogue(agonist,antagonist)

Front 59

benefits of GnRH analogue therapy.

Back 59

improvement of menorrhagia and may produce amenorrhea

improvement of anaemia

relief pressure symptoms

reduction in size 50% when used for a period of 6 months

reduction of vascularity
of tumor

reduction of blood loss during myomectomy

may facilitate laparscopic or hyteroscopic surgery

Front 60

pressure symptoms.

Back 60

~bladder: frequent urination.
obstructed urination.

~rectum: defecation, constipation.

Front 61

surgical treatment for fibroma.

Back 61

myomectomy.

endoscopic surgery.

hysterectomy.

aa embolization.

Front 62

what is myomectomy?

Back 62

enucleation of myomata
from uterus.

Front 63

indication of myomectomy.

Back 63

patient is in reproductive period desiring of having baby.

in case of recurrent miscarriage.

Front 64

contraindication of myomectomy.

Back 64

infected fibroid.

big broad ligament fibroid.

too many fibroid.

Front 65

vaginal myomectomy.

Back 65

usually it is pedunculated submucous myoma.

if the myoma is big: Morcellation. removal of tumor by metal piece.

if myoma is of moderate size: twisting it.

Front 66

hysterocopy-endoscopic surgery.

Back 66

fibroid of 3-4 cm is resected with hysteroscope.

pedicle base of fibroid is coagulated using electrocautery.

Front 67

complication of hyteroscopic surgery.

Back 67

uterine penetration.

fluid overload.

hemorrhage.

Front 68

indication of emergency in fibroid.

Back 68

torsion of subserous pedunculated fibroid.

massive intra peritoneal haemorrhage following rupture of veins over sub serous fibroid.

uncontrolledinfected fibroid.

uncontrolled bleeding fibroid.

Front 69

hw is asymptomatic fibroma dealt?

Back 69

observation.

surgery.

Front 70

how is observation management done?

Back 70

patient has to be observed for at least 6 months, frequent visit to doctor to measure growth of the fibroma.

if the symptoms appear or fibroma has increase in size rapidly, surgical management is considered.

Front 71

indication of surgery in asymptomatic fibroid.

Back 71

size > 12 weeks of pregnancy

growth of fibroid during observation period.

subserous pedunculated fibroma

unexplained infertility with distorsion of uterine cavity

unexplained recurrent abortion

when the fibroma located at lower part of uterus and likely to complicate delivery.

Front 72

what u should do if in case of observation of asymtomatic patient, the tumor doesnt grow in size and remain symptomless?

Back 72

follow up

Front 73

what are the difference between polyp and myoma? #######

Back 73

polyp usually appear smaller.

polyp may regress.