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TRANSCRIPT
BENIGN
CONDITIONS OF
THE UTERUS
Prof. Leon SnymanM.B.Ch.B, M.Prax.Med, M.Med (O&G), FCOG(SA)
Gynaecologic Oncology Unit
Department Obstetrics & Gynaecology
Introduction
• Uterus consists of:
• Cervix
• Corpus
• Fallopian tubes
• Ligaments
Cervix
• Benign tumours
– Endocervical polyp
– Cervical myoma
– Cervical papilloma
– Others
Cervix
• Other
– Nabothian cysts
– Columnar epithelium eversion
Cervix
• Infections
– Condyloma
– Herpes simplex
– Cervicitis (Chlamydia)
– Bilharzia
– TB
Uterus
• Benign tumors
– Leiomyomas are by far the most common
uterine benign tumors
– Endometrial polyps
• Other benign conditions
– Developmental abnormalities
– Adenomyosis
– Dysfunctional uterine bleeding
Prevalence of leiomyomas
• Present in at least 20% of all women of
reproductive age
• More prevalent in black women
• Familial incidence
Definition
• Benign neoplasm consisting of smooth
muscle and connective tissue.
Etiology
• Unknown
• Genetic tendency
• Risk
– Race
– Obesity
• Risk
– Oral contraceptive
Different types
• Pedunculated
• Subserosal
• Intramural
• Submucosal
• Cervical
• Parasitic
Clinical presentation
• Asymptomatic
• Presence of a pelvic mass
• Abnormal uterine bleeding
• Pain:
– Backache, dysmenorrhoea, dyspareunia
• Pressure symptoms
• Urinary symptoms (retention, frequency)
Clinical presentation
• Controversial:
• Infertility
– Less than 3% of infertile patients
– Submucosal leiomyomas
• Pregnancy complications
– Most have uncomplicated pregnancies and
deliveries
Complications
• Torsion of pedunculated myoma
• Bleeding and anaemia
• Degeneration:
– Red, hyaline, mucoid, cystic, fat
• Calcification
• Malignant changes (0.1 to 0.5%)
On examination
• Abdomen:
– Palpable mass from pelvis
• Bimanual examination
– Palpable mass
– Enlarged uterus
Differential diagnosis
• All causes of abnormal uterine bleeding
– Ca cervix and Ca endometrium
– Polyps
– Pregnancy
Differential diagnosis
• All causes of pelvic masses
– Ovarian
– Inflammatory
– Pregnancy
– Bladder
– GIT
– etc
Special Investigations
• Cervical smear
• Endometrial biopsy
• Hematocrit and platelets
• Other investigations
as indicated
• Ultrasound
Treatment
• Different options available according to
individual patient’s needs
• Surgical
• Non-surgical
Non-surgical
• Expectant with follow-up
• Medical treatment
– GnRH analogues
• Short term: pre-op, anaemia recovery, peri-
menopausal
• Regrowth after cessation of therapy
• Bone loss
More non-surgical
– Danazol
– Mifepristone
• Invasive management
– Uterine artery embolisation
• Effective modality over short term
• 3% failure rate
• Especially small myomas
Surgical
• Myomectomy
– Where fertility is wanted
– Submucosal myomas with operative
hysteroscope
– Laparoscopy for small pedunculated and
subserosal myomas
– Laparotomy for bigger and intramural
myomas
More surgical options
• Hysterectomy
• Vaginal myomectomy for prolapsing
pedunculated submucosal myomas
Adenomyosis
• Ingrowth of the endometrium into the
uterine musculature
• Causes secondary dysmenorrhea,
dyspareunia and menorrhagia
• Often asymptomatic
• Uterus diffusely enlarged, soft and tender
Adenomyosis
• No special investigations
• Management
– Symptomatically (NSAIDS, OC, Progestins)
– Hysterectomy
Benign tumours Fallopian
tubes
• Adenomatoid tumor
• Other (rare)
– Leyomyoma, adenomyomas, lypomas etc.
– Cysts
• Hydatid cyst of Morgagni (remanat of accessory
Muller duct system)
• Salpingitis istmica nordosa (epithelium in
myosalpinx
• Polyps
• Endosalpingiosis
Ligaments
• Lyomyomas and endometriosis can
involve these structures