This site or third-party tools used by this make use of cookies necessary for the operation and useful for the purposes described in the cookie policy. By clicking on "I accept" you consent to the use of cookies.

Leiomyoma or fibroid or fibromyoma

  1. Gastroepato
  2. Oncology
  3. Leiomyoma or fibromyoma
  4. Uterine pathology
  5. Polyp of the cervical canal of the uterus

 

notes by  dr Claudio Italiano

Leiomyoma or fibromyoma

These terms are equivalent and in practice the fibroma is used above all. It is the benign tumor that most often meets in gynecological pathology (it is present in 15-20% of women).

It may be unique, but very often it comes to multiple formations, variously located in the uterus. Also the volume of the fibroid is extremely variable, from that of a grain of rice to masses weighing several kilograms. The age of the highest incidence is between 35 and 50 years; under the age of 20 is very rare.

Leiomyomas represent the most common benign uterine tumors. Typically asymptomatic, they may determine menometrorrhagia, abdominal pain and infertility.

They may be singular or multiple and may have variable size. When leiomyomas increase in size, their vascular supply may become insufficient determining different types of degeneration: hyaline, myxoid, cystic and hemorrhagic (red). Differential diagnosis includes adenomyosis, solid adnexal masses, focal contraction of myometrium and leiomyosarcomas of the uterus

Pathological anatomy

The fibroid of the uterus usually (95%) is localized in the body and only rarely in the neck (5%) and tends to assume, albeit in the extreme variability of the contours, the shape of a spheroidal nodosity.

Leiomyomas generally interest the myometrium of uterine corpus but they may also be found in the cervix (about 8% of cases). According to their location they are classified as submucosal, intramural  or subserosal. This classification has real clinical importance as symptoms and treatment options vary in relation to the different type of leiomyomas1 . Submucosal leiomyomas are the least common (about 5% of cases), but they determine clinical symptoms more frequently than the other types and can be associated with dysmenorrhea, menorrhagia and infertility.

Depending on the uterine layer and the site where they develop, fibroids can be distinguished:

1) Sub-sessile sessile or pedunculated, when they develop under the peritoneum that covers the uterus. These nodes, although rarely, can assume adhesions with the intestine or with the omentum and sometimes can even be fed by omental vessels.
2) Intramural or interstitial, when the node or nodes develop in the thickness of the myometrium.
3) Submucosal, sessile or pedunculated, when they protrude into the uterine cavity, lifting the endometrial mucosa and sometimes ulcerating it.
4) Infralegamentary, when, developing from the lateral margins of the uterus, especially in the isthmic area, the fibroids split the two peritoneal pages of the broad ligament, growing inside it.
5) Suboperitoneal or cervical: the nodes, if they develop from the upper portion of the neck, lift the pelvic peritoneum and assume close relations with the ureter and the uterine artery; if the nodes develop from the intravaginal portion of the neck, they tend to occupy the vagina instead.

When cut, the fibroma has a rather hard consistency and a color that varies from whitish to reddish depending on whether the fibrous component (white) or the muscular component (red) is prevalent. The consistency is much harder, the more abundant the fibrous tissue is.

On the contrary, when the component is almost all muscular, intense vascularization can exist and consequently the hemorrhagic extravasations (soft myomas or red myomas) are frequent.

Fibroids, not having a true capsule are separated from the myometrium by a thick layer of clear areolar connective, very easily can be enucleated.

The vessels from which the tumor is fed penetrate into the pseudocapsule. Usually there is only one artery with a J-2 mm caliber while the other vessels are very small. Macroscopically, the structure appears uniform or in bundles. in concentric or spiraliform course.

The intramural fibroma. especially if single and voluminous (10-15 cm of diameter) can cause a uniform growth of the uterus, with enlargement and lengthening of the uterine cavity.

On the other hand, the presence of multiple nodes often makes the irregular cavity.

Histologically, the constitutive elements of the fibroma are in part represented by smooth muscle cells with spindle nuclei. These elements are usually larger than normal myometrial elements, and stand out in colored eosin preparations for a darker color compared to the latter. The muscle cells are oriented in various directions and between them there is a more or less abundant stroma. Vessels are usually more evident on the periphery, while in the center the spraying in certain fibroids is almost absent.

 This explains the frequent facts of necrosis, which occur inside the fibroma.

The myometrium surrounding the tumor node very often presents hypertrophy; when this hypertrophy is spread regularly to the entire uterus, it is called "fibrous uterus". In the fibrous uterus the presence of true fibroids may also be lacking. Also the endometrium is sometimes subject to modifications due to the presence of fibrous nodes.

Mostly there is a state of congestion of the uterine mucosa that sometimes appears thickened and hyperplastic. With the growth of the fibroma and the passage of time the muscular contingent tends to become less conspicuous due to the atrophy of the muscular elements, while the fibrous contingent becomes more conspicuous. Van Gieson - Mallory stains can distinguish the hips for the hyperestrogenism situation that is not rarely associated. In the cases instead of submucous fibroids the compression exerted on the mucosa that is raised, can determine the atrophy and also the necrosis. Also the ovary can present a transformation to polycystic ovary.

This aspect can be an expression of a high production of estrogen.


Histogenesis

Today it is admitted that the fibroma derives from the muscular elements of the uterus and not from the fibrous ones. For this reason many prefer to call it leiomyoma. It is only discussed if the uterine muscular elements that give rise to the fibromyoma are immature elements or are mature elements or muscle cells of the vessel wall.

The fact that the fibroma develops preferably in the reproductive age, which in most cases tends to remain stationary and sometimes regress in menopause, and the fact that often associated with the fibroma a glandular hyperplasia of the endometrium with polycystic ovaries have attracted the attention on a possible hormonal pathogenesis of the tumor.

That would be the hyperestrogenism that would favor its onset and development.

oncology

Other topics of Gastroepato

Cardiology

Dermatology

Diabetology

Hematology

Gastroenterology

Neurology

Pneumology

Oncology