The leiomyoma of the uterus is well separated from the myometrium, it has no separate capsule. It feels solid, consists of spherical nodules and is often a multiplex tumor. Its size varies between wide limits, from a few mm to the same size as a full term pregnancy.
While they grow due to insufficient blood supply with time secondary degenerative processes may develop: certain areas may become softened and jelly (degeneratio hyalinea); the degenerated areas may liquify (degeneratio cystica); calcification can occur in areas with insufficient blood supply (calcificatio); mainly during pregnancy - due to compression of the veins - hemorrhagic necrosis may occur (degeneratio carnosa); after giving birth and during post menopause - due to decreasing number of smooth muscle cells - the tumor generally reduces in size (atrophia); the necrotic areas may secondarily get infected (necrosis septica).
A special manifestation of the uterus myomatosus gravis is the parasita myoma. It primarily forms when the gelatinous subserosal nodule receives blood supply from another organ (mostly the great omentum), while the original stem atrophies’. Secondarily it forms as a complication from conservative surgical intervention: during the dissection of a tumor(morcellatio) the pieces of the myoma left in the abdomen adhere onto the surface of other visceral organs.
The intramural and submucosal nodules which deform the shape of the uterus may disturb the blood flow of the endometrium, may change the motility of the uterus and the fallopian tubes and distort the uterine cavity, which can cause infertility. In approximately 5-10% of the cases of female infertility is due to cancer of the endometrium. In pregnancies conceived in presence of a myoma, spontaneous abortion and premature delivery is more common than in the average population. During pregnancy the already existing myoma is not likely to grow significantly, if yes than it is likely to happen in the first trimester. Necrosis can occur inside of a rapidly growing myoma nodule which may cause acute abdominal pain and premature contractions.
During delivery lying, posing and pelvic head-fitting disorder may happen. Multiplex nodules may cause contraction weakness and bigger nodules close to the cervix may create a barrier for delivery. In the postpartum period nodules can inhibit regular contraction of the uterus, which may lead to atony or more bleeding.
Leiomyosarcoma occurs in 0.1-0.3% of clinically diagnosed myoma cases, in most of the cases it is de novo, malignant degeneration of benign lesions is uncommon.
Utolsó módosítás: 2014. February 12., Wednesday, 10:15
