leiomyomas
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Uterine LeiomyomaUterine Leiomyoma
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Uterine LeiomyomaUterine Leiomyoma
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leiomyomata
Uterine fibroids
myoma
fibromyoma
Uterine LeiomyomaUterine Leiomyoma
Benign neoplasm of smooth muscleBenign neoplasm of smooth muscle Estrogen sensitiveEstrogen sensitive Surrounded by pseudocapsuleSurrounded by pseudocapsule Rare malignant potential Rare malignant potential
(Leiomyosarcoma)(Leiomyosarcoma)
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LocationLocation
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LeiomyomaLeiomyoma
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LeiomyosarcomaLeiomyosarcoma
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PrevalencePrevalence
20-30% of reproductive-age women20-30% of reproductive-age women Most common indication for surgery Most common indication for surgery
in U.S. womenin U.S. women 1/3 of all hysterectomies1/3 of all hysterectomies 3-fold higher incidence rate in Black 3-fold higher incidence rate in Black
women [1,2]women [1,2]
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Risk factorsRisk factors
African American African American NonsmokingNonsmoking ObeseObese PerimenopausalPerimenopausal Gene mutationsGene mutations
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Genetic basis?Genetic basis? Twin studies [3]Twin studies [3] First-degree affected relatives [4,5]First-degree affected relatives [4,5] Race as risk factorRace as risk factor Hereditary Leiomyomatosis and Renal Hereditary Leiomyomatosis and Renal
Cell Carcinoma (HLRCC) [6]Cell Carcinoma (HLRCC) [6] Cutaneous and uterine leiomyomataCutaneous and uterine leiomyomata At risk for papillary renal cell carcinoma At risk for papillary renal cell carcinoma
(women > men) [7,8](women > men) [7,8] Women: increased risk of leiomyosarcoma Women: increased risk of leiomyosarcoma
[7,8][7,8] Mutation in fumarate hydratase geneMutation in fumarate hydratase gene
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Signs and SymptomsSigns and Symptoms BleedingBleeding PressurePressure PainPain InfertilityInfertility Pregnancy complications: cesarean Pregnancy complications: cesarean
delivery, breech presentation, delivery, breech presentation, malposition, preterm delivery, placenta malposition, preterm delivery, placenta previa, severe postpartum hemorrhage [9]previa, severe postpartum hemorrhage [9]
50-60% Asymptomatic50-60% Asymptomatic
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DiagnosisDiagnosis
HistoryHistory Bimanual pelvic or abdominal examBimanual pelvic or abdominal exam Pelvic ultrasound - most commonPelvic ultrasound - most common MRI, HSG, sonohystogram, MRI, HSG, sonohystogram,
hysteroscopyhysteroscopy
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TreatmentTreatment
Expectant management - most casesExpectant management - most cases Indications for treatmentIndications for treatment
Abnormal uterine bleeding, causing Abnormal uterine bleeding, causing anemiaanemia
Severe pelvic painSevere pelvic pain Large or multipleLarge or multiple Obscuring evaluation of adnexaeObscuring evaluation of adnexae Urinary tract symptomsUrinary tract symptoms Postmenopausal or rapid growthPostmenopausal or rapid growth
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Treatment ChoicesTreatment Choices
Medical therapiesMedical therapies Medroxyprogesterone (Provera)Medroxyprogesterone (Provera) DanazolDanazol GnRH agonists (nafarelin acetate, GnRH agonists (nafarelin acetate,
Depot Lupron)Depot Lupron)
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Treatment ChoicesTreatment Choices
MyomectomyMyomectomy HysteroscopicallyHysteroscopically LaparoscopicallyLaparoscopically AbdominallyAbdominally
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Treatment ChoicesTreatment Choices
Uterine Artery Embolization (UAE)Uterine Artery Embolization (UAE)
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Treatment Choices:Treatment Choices:MR guided Focused MR guided Focused
UltrasoundUltrasound
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Treatment ChoicesTreatment Choices
HysterectomyHysterectomy VaginalVaginal AbdominalAbdominal
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Gene TherapyGene Therapy
Gene-based vectors [13]Gene-based vectors [13] Dominant-negative form of estrogen Dominant-negative form of estrogen
receptor to inactivate estrogen receptor to inactivate estrogen signaling and induce apoptosis [13]signaling and induce apoptosis [13]
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Follow-up (Treatment)Follow-up (Treatment)
Monitor size and location of fibroidsMonitor size and location of fibroids Indications for treatmentIndications for treatment
Abnormal uterine bleeding, causing Abnormal uterine bleeding, causing anemiaanemia
Severe pelvic painSevere pelvic pain Large or multipleLarge or multiple Obscurrng evaluation of adnexaeObscurrng evaluation of adnexae Urinary tract symptomsUrinary tract symptoms Postmenopausal or rapid growthPostmenopausal or rapid growth
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