Case Presentation:
Uterine Myoma
Marijesmar Gonzalez Valle
OB GYN Clerkship
Dr. Rojas
July 19, 2007
CC:
Patient refers: Me crecio la barriga.
States having pelvic pain.
HPI:
Case of a 54 year old patient G3P3A0 that
was admitted to the hospital due to pelvic
pain. Patient refers low abdominal
enlargement. Ultrasound revealed uterine
myomas. Patient was admitted and schedule
for surgery. During surgery uterine myomas
were removed as well as adhesions from
bowels to tube.
Past Medical History:
Systemic Illness
HTN
DM II
Asthma
Constipation
Family History
HTN: 2 sons
DM: Sister,Uncles
CVD: Grandfather
Anxiety: Mother
H. pylori: Mother
OB Gyn Medical History:
G3P3A0: (Gestational
diabetes on 3rd pregnancy)
Marital Status: Married
Religion: Catholic
Sexual Partners: 1
First Coitus: 20 years old
Menarche:10 years
Menses: irregular
sometimes twice per month
Dysmenorrhea: No
LMP: States that does
not remember
Dyspareunemia: No
STDs: No
Contraceptives:
Pills
Condoms
NuvaRing
Dx: Pelvic pain due to
Uterine Myoma
Labs:
CBC
WBC: 15.6
X 10^3/ uL
HgB: 13.9
g/dL
Plat: 269 x
10^3/ uL
Hct: 39.8%
CHEM 7
Na+ 137.3
K+ 4.64
Anion Gap: 8.4
Cl- 101.6
BUN 15
HCO 3- 27.3
Creat: 0.6
Gluc: 222
Osm: 282.1
Dx:
Pelvic Pain
Uterine Myoma
Adhesion from bowels to tube
Mild Cystocele
Procedures:
Total Abdominal Hysterectomy
Right Salpingoopherectomy
Lysis of Adhesion
Vaginal Anterior Wall Suspension
Uterine Myoma
Are localized smooth muscle cell
proliferation surrounded by a
pseudocapsule of compressed muscle
fibers.
Up to 30% of American women have
uterine myomas.
Uterine Myoma
DNA studies revealed:
That each myoma arises from a single
smooth muscle cell
The smooth muscle cell is vascular in
origin.
Considered to be benign tumors that are
hormonally responsive, this is because
estrogen usually induces their rapid growth in
high estrogen states.
Uterine Myoma
Estrogen
Production of progesterone receptors in the
myometrium
Production of several growth factors
Growth of myomas
Uterine Myoma
Types of Uterine Myomas
Intramural:
Uterine enlargement
Subserous:
Pedunculated
Submucous: 5%
Intracavitary:
Abnormal bleeding
and cramping
Signs and Symptoms:
Bleeding is the most common presenting
symptom.
Progressive increase in pelvic pressure
Pelvic Pain
Hypermenorrhea
Dysmenorrhea
Dyspareunia
Metrorrhagia
Diagnosis
Abdominopelvic examination
Pelvic Ultrasound
Endometrial Biopsy
Hysteroscopy
Laparoscopy
Computerized Axial Tomography
MRI
Risk Factors:
High estrogen states:
Pregnancy
Use
of oral estrogen
Estrogen producing tumors
Later reproductive and perimenopausal
age groups.
3-9 times higher in African- Americans
Clinical Presentation:
The most common clinical
presentation is the development of
progressively heavier menstrual
flow that last longer than the normal
duration (menorrhagia).
Clinical Presentation:
Another presentation is a sense of
progressive pelvic fullness caused by a
slowly enlarging intramural or
subserous myomas, which on occasion
may attain a massive size.
Pelvic pain manifest by the onset of
secondary dismenorrhea.
Complications
Chronic Iron Deficiency Anemia
Urination problems
Hydroureter
Hydronephrosis
Infertility
Miscarriage
Premature Delivery
Management of Condition
Minimize Uterine Bleeding:
Intermittent
Progestin
supplementation
Prostaglandin synthetase inhibitors
GrRH agonist: temporally chemically
induced menopause
Danazol
Mifepristone (RU-486)
Treatment
Myomectomy
Laparotomy
Hysterectomy
Uterine Artery Embolization (UAE)
Bibliography:
Beckman, Charles R.B., Ling, Frank W., Smith, Roger P., Barzansky,
Barbara M., Herbert, William N.P. & Douglas W. Laube. Obstetrics
and Gynecology. Uterine Leyomioma and Neoplasia. 5th edition.
Lippincott Williams & Wilkings. 2006. pp 448-454.
Edwards RD. Moss JG. Lumsden MA. Wu O. Murray LS. Twaddle S.
Murray GD. Committee of the Randomized Trial of Embolization
versus Surgical Treatment for Fibroids. Uterine-artery embolization
versus surgery for symptomatic uterine fibroids Journal Article.
Multicenter Study. New England Journal of Medicine. 356(4):360-70,
2007 Jan 25.
Hovsepian DM. Ratts VS. Rodriguez M. Huang JS. Aubuchon MG.
Pilgram TK. A prospective comparison of the impact of uterine
artery embolization, myomectomy, and hysterectomy on ovarian
function. Journal of Vascular & Interventional Radiology. 17(7):11115, 2006 Jul.
[Link]/[Link]
