[Local medical care]Uterine fibroids VS myadenomas cause great difference in treatment

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Text: Yang Qianni Arrangement: Liang Yingxiu

(Kuala Lumpur News) Uterine fibroid is a common benign tumor in the female pelvic cavity, and it is more likely to occur in older, nulliparous, family history and African-Americans. It affects 40% of women over the age of 38 in the United States and 70% of women over the age of 50.

75% of patients with uterine fibroids are asymptomatic

Dr. Alex Tang Ah Lak, Consultant of Vascular and Interventional Radiology, pointed out that uterine fibroids are also called uterine leiomyomas (leiomyoma). As the name suggests, they grow from the smooth muscle of the uterine wall. Uterine fibroids are often multiple, meaning that multiple tumors exist at the same time.

Uterine fibroids can be classified according to the location of growth (see Figure 1)

Intramural fibroids: They grow in the muscle layer of the uterine wall, accounting for about 90%.

Submucosal fibroids: grow out of the muscle layer and protrude inward into the uterine cavity.

Subserosal fibroids: grow from the muscle layer to the pelvic cavity and protrude outward.

Pedunculated fibroids: Fibroids can be attached to the uterus by a peduncle.

He said that according to the “Uterine Bleeding and Pain Research Report” (UBP-WRS), which interviewed more than 20,000 women in 8 countries in 2009, about 70% to 75% of women with uterine fibroids have no symptoms, and most of them have no symptoms. been diagnosed.

Therefore, the growth of uterine fibroids is thought to be related to not having children (causing estrogen levels to rise) or to supplementing estrogen.

“58% of symptomatic women presented with abnormal uterine bleeding, especially heavy bleeding and prolonged menstrual periods. They had ‘gushing-type’ bleeding more often than women without fibroids and required heavy tampons or tampons.

Another 23.5% had dyspareunia, dysmenorrhea and non-cyclic pelvic pain.

32.6% of women have symptoms of frequent urination, nocturia and occasional constipation due to uterine fibroids oppressing adjacent organs such as the bladder.“

Ultrasound scans are cheap and most commonly used

He said that uterine fibroids are also one of the main causes of infertility. In 35% of patients with uterine fibroids, the narrowing of the isthmus of the fallopian tube affects the transportation and movement of sperm and eggs; or the fibroids affect the uterine cavity The environment, especially submucosal fibroids can deform the uterine cavity, interfere with the implantation of fertilized eggs, and affect fertility.

Uterine fibroids larger than 6 cm or multiple will affect a woman’s chances of pregnancy, or increase the risk of miscarriage and intrauterine growth restriction (IUGR), and 7% of patients will be born prematurely.

“There are several ways to detect uterine fibroids. The first is clinical physical examination. Although most people do not have any symptoms, there are also many patients with large uterine fibroids that have a mass effect and occupy or squeeze adjacent organs. For example, the pelvis feels heavy, and the abdomen feels lumpy when touched.”

He revealed that ultrasound scanning is the most commonly used basic detection and evaluation tool for uterine fibroids. It is low-cost and has two methods, transabdominal and transvaginal, and is mostly used by gynecologists. Both ultrasound scans are equally effective and can observe blood flow in the ovaries, bladder, intestines, and arteries and veins.

The sensitivity, specificity and accuracy of ultrasound were 60%, 99% and 87%, respectively. Its specificity is high, which means that when doctors can observe tumors through ultrasound, but most of the time they cannot identify uterine fibroids and uterine fibroids, as well as confirm the true number and location.

“It can sometimes be challenging to diagnose a condition with an ultrasound scan, for example, when obese patients have a thick layer of fat or a deep uterus (obstructed by the bladder or large intestine), which can interfere with the scan results .I think about 30% to 40% of patients cannot rely on ultrasound scans to find fibroids, especially small ones.”

In addition, the accumulation of clinical experience is also very important for medical staff who operate ultrasound equipment, and whether they have received professional training and the type of equipment used will also affect the scan results.

MRI differential diagnosis of both

Confirm the location of the number of lesions

Using high-resolution magnetic resonance imaging (MRI), in the detection of uterine fibroids, it can reach 86% to 92% sensitivity, 100% specificity and 97% accuracy (accuracy).

Through MRI scanning, doctors can not only accurately identify uterine fibroids or uterine fibroids, but also confirm the number and location of lesions and check the structure around the uterus. Usually white fibroids are composed of smooth muscle cells alone; while black fibroids is usually mixed with fibroids.

Chen Shaofa said that due to the location of the uterus close to the rectum and bladder, the ureter is cut in error is also one of the risks of hysterectomy.

“So some gynecologists also rely on MRI scans before performing hysterectomies to prevent accidents and injuries.”

Hysteroscopic unresectable large fibroids

“As for the computerized tomography (CT) scan, it is of limited use in the detection of uterine fibroids, it cannot clearly distinguish uterine fibroids from fibroids. Although not the best routine screening tool, CT scans are useful for Cancer staging is very different.”

“In addition, the iodine contrast agent (iodinated contrast) used in CT scans may have the risk of affecting the kidneys, and patients will also receive a certain radiation dose during the scan.”

He pointed out that hysteroscopy is to use an endoscope to enter the uterus through the vagina and cervix, so that the uterine cavity can be inspected or operated, and small uterine fibroids or polyps can be removed.

“Sometimes gynecologists perform hysteroscopy on patients, only to find out that fibroids or polyps are too large to remove. If you have an MRI scan, these steps can actually be avoided.”

He emphasized that it is often confused with uterine fibroids clinically, especially when it looks very similar through ultrasound examination, but it is actually quite different from adenomyoma.

“Distinguishing the two is very important because the cause and treatment strategy are completely different. Adenomyosis is due to the hyperplasia of the endometrium, which invades the muscle wall of the uterus and generates new endometrial tissue within the myometrium can be divided into two forms (see Figure 2)

●Focal type (focal): Under ultrasound observation, a mass suspected of uterine fibroids is formed, which is called “uterine fibroids”.

●Diffuse (diffuse): uterine junctional zone (uterine junctional zone) thickening and swelling.

Uterine fibroids are common in multiparous women over the age of 30, causing symptoms including pelvic pain, menorrhagia, dysmenorrhea, etc. 36% to 40% are related to endometriosis.

Fibroids were found in 31% of hysterectomy samples.

endometriosis fibroid

It’s worth noting, he said, that fibroids can co-exist with fibroids.

“I once met a patient clinically. She was a 44-year-old single primary school teacher. Through MRI scanning, it was found that 30% of the tumors in the uterus were pure fibroids, 30% were fibroids, and the other 40% were fibroids. Mixing the two makes it trickier to treat.”

He pointed out that since the abnormal tissue formed by uterine fibroids has no clear boundary with normal tissue, it is not easy to remove it completely through surgery.

“If a woman has simple uterine fibroids, there are many ways to deal with them, such as hormonal drugs, hysterectomy, myomectomy (myomectomy), uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU, and However, if there are more fibroids, the effect of hormone therapy will be reduced.”

“Hence, her only choice is UAE, because whether it is HIFU or RFA, it is only suitable for one or two local lesions, and cannot treat mixed uterine fibroids, large-scale and diffuse uterine fibroids.”

Fibroids and fibroids on an MRI scan, usually appearing black. Figure 5: Irregular thickening of the junction of the uterus, showing diffuse myadenomas; Figure 6, a mixture of diffuse and local, showing that a mass has formed.

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