{"paper_id":"9a464690-92e5-4923-b46d-2353ecd33e80","body_text":"~ 138 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2022; 6(1): 138-140 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2022; 6(1): 138-140 \nReceived: 18-10-2021 \nAccepted: 02-12-2021 \n \nDr. Jayshriben Rajeshkumar \nMajithiya \nAssistant Professor, Department of \nObstetrics & Gynecology, Banas \nMedical College and Research \nInstitute, Palanpur, Gujarat, India \n \nDr. Rajeshkumar Hiralal Majithiya \nAssistant Professor, Department of \nSurgery, Banas Medical College \nand Research Institute, Palanpur, \nGujarat, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Jayshriben Rajeshkumar \nMajithiya \nAssistant Professor, Department of \nObstetrics & Gynecology, Banas \nMedical College and Research \nInstitute, Palanpur, Gujarat, India \n \nA clinicopathological relation of the uterine leiomyoma: \nA retrospective analysis \n \nDr. Jayshriben Rajeshkumar Majithiya  and Dr. Rajeshkumar Hiralal \nMajithiya \n \nDOI: https://doi.org/10.33545/gynae.2022.v6.i1c.1126 \n \nAbstract \nIntroduction: Leiomyomas also known as fibromyomas, fibroids or myomas are the commonly  \nencountered benign uterine neoplasms in women of reproductive age group. They accounts for 5 -20% of \nall women in reproductive age group. This study is an attempt to analyze the clinico pathological spectrum \nin cases of Leiomyoma of the uterus. \nMaterials & Method: A clinical study of 100 cases of fibroid uterus was made in the Hospital attached to \nMedical College. The cases are selected by random allocation. On admission, a detailed history, clinical \nexamination and investigations were made. Examination und er general anaesthesia was not made in our \nstudies. Diagnosis was confirmed by scanning in all cases. Diagnostic curettage was done to rule out any \nendometrial pathology especially in elderly patients. \nResults: The most common benin tumor of the pelvins is  Leiomyoma. Histopathology report showed \nproliferative endometrial in 66 cases, secretary changes were noted in 12 patients, endometrial hyperplasia \nwas seen in 5 cases, cystic glandular hypertrophy was seen in 3 cases, atrophic endometrial occurred in 8 \npatients. The results were inconclusive in 6 patients. \nDiscussion & Conclusion: Leiomyoma is the most common benign tumor of the pelvis. The trends in the \nage incidence have remained the same, the occurrence of fibroid is rare before 20 years of age, and th ey \ncease to grow after menopause, thereby commonly affecting women of child bearing age, most common in \nthird decade. Presence of proliferative endometrium, adenomyosis and cystic ovaries are all indicative of \nhyperestrogenic state associated with development of fibroids. \n \nKeywords: Leiomyoma, histopathology, hysterectomy, endometrial changes \n \nIntroduction  \nLeiomyomas also known as fibromyomas, fibroids or myomas are the commonly encountered \nbenign uterine neoplasms in women of reproductive age group. They accounts for 5-20% of all \nwomen in reproductive age group (Crum C P, 2004)  [1]. They need hormonal milieu for their \ngrowth and maintenance as evidenced by the molecular studies that leiomyomas which exhibit \nmore estrogen receptors than the normal myometrium (Gull, 2001) [2]. The unopposed estrogenic \nstimulation manifests commonly as endometrial proliferative phase or hyperplasia (Witherspoon \nT J, 1993) [3, 4]. \nLeiomyomas are the most common uterine neoplasms. The clinical presentation of leiomyomas \ndepends on their size and location. They cause many signs and symptoms, the most common of \nwhich are pain, a sensation of pressure, and abnormal uterine bleeding. Leiomyomas need \nhormonal milieu for their growth and maintenance as evidenced by the molecular studie s that \nthey exhibit more estrogen receptors than normal myometrium [5]. \nDespite being the most common tumor, the etiology still remains a speculation. Genetic and \nhormonal factors have been implicated. Although estrogen, growth hormone, and possibly \nhuman placental lactogen have been implicated, the role of estrogen in their growth is \nsignificant. Studies using glucose -6-phosphate dehydrogenase isoenzyme suggest that each \nfibroid apparently arises from a single cell within the myometrium [6]. \nMost cases of leiomyoma are asymptomatic and need no treatment. Among symptomatic cases, \nmenstrual disturbances are the most common symptom and leads to anaemia in majority of \npatients. Other common symptoms are abdominopelvic pain and pressure symptoms. Pressure \nsymptoms are urinary frequency and urgency which may develop due to large size fibroid or \nsudden increase in size of the fibroid [7, 8].\n\n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 139 ~ \nHeavy menstrual bleeding is the most common clinical symptom \nseen in intramural leiomyoma since it interferes with myometrial \ncontraction. This study is an attempt to analyze the clinico \npathological spectrum in cases of Leiomyoma of the uterus. \n \nMaterials & Method \nA clinical study of 100 cases of fibroid uterus was made in the \nHospital attached to Medical College and Research Institute. \nThe cases are selected by random allocation. On admission, a \ndetailed history, clinical examination and investigations were \nmade.  \nExamination under general anaesthesia was not made in our \nstudies. Diagnosis was confirmed by scanning in all case s. \nDiagnostic curettage was done to rule out any endometrial \npathology especially in elderly patients and to know the \nhormonal status in infertile patients. In Patients with infertility, \nsemen analysis of husband and tubal testing were made before \nundertaking conservative surgery.  \n \nAt laparotomy: Size of uterus, number and situation of fibroids, \ncondition of tubes and ovaries were noted. In cases posted for \nmyomectomy, tubal patency was tested utilising methylene blue. \nThe ovaries were conserved in cases o f hysterectomies unless \nassociated with pathology and in elderly patients. The removed \nspecimen was cut anteriorly in the midline and near the cornu to \ninspect the cavity and seedling fibroids. The specimen was sent \nfor histopathological examination of endometrial, myometrium. \nMicroscopic examination was done: \ni. To confirm the lesions. \nii. For degenerative changes. \niii. Associated endometrial pathology. \niv. Associated with adenomyosis and \nv. For changes in the ovaries, tubes and cervix. \n \nResults  \nThe most common benin tumor of the pelvins is Leiomyoma. \nThe maximum diagnosis and patients admission in the medical \ncollege and associated hospital was due to leiomyoma. It also \naccounts for the most common indications for hysterectomy. A \ntotal of 100 cases were selected in the study. \nFrom the data collected after completion of the study it was \nfound that Leiomyomas are most commonly seen in the women \nin the women of child bearin age that mostly occur in the 3 rd and \n4th decade of life. The mean age of the patients included in the \nstudy was around 41 years. The youngest women in the study \nwere found to be 22 year and oldest patients was around 60 \nyears. Though Leiomyoma is a disease of low parity, in our \nstudy we have noted it to be common in multiparous women. \nIn around 20 cases the s ymptom of dysmenorrhea was recorded. \nIn submucous and intramural fibroids patients had symptoms of \nspasmodic dysmenorrhea. As the reason and presence of \npathology in pelvic due to increase in vascularity in the pelvic \narea resulted in congestive dysmenorrh ea. In 12 patients the \nwhite discharge was seen, it was seen in cases of prolapsed and \nfibroid polyp. In 33 patients the complain of pain in abdomen \nwas recorded. In maximum cases the pain was due to cystic \novaries and in other cases the pain was due to en dometriosis, \nurinary tract infection and cholelithiasis. In 13 patients there was \ncomplain of presence of mass. In 15 patients there were problem \nof urinary tract, which is associated with cervical fibroid.  \nIn 15 cases the primary infertility was observed , the reason for \ninfertility was not known. None of the patients had any \ndiscomfort of bowel. In 5 cases the symptoms like vomiting, \npost coital bleedin, abdominal discomfort and fever was \nrecorded. In total of 40 cases there was presence of anemia. All \nthe patients were hospitalized, after detailed examination and \ninvestigations, the patients were treated for anaemia and other \nmedical disorders. Patients underwent surgery. The type of \nsurgery was chosen depending on the age of the patient, \nassociated and pathology \nThe size of the fibroid uterus differs from few centimetres to 20 \nweeks of ravid uterus. In about 68 cases the size of 16 weeks \ngravid uterus were seen, in 23 cases there were of the size \nbetween 16 -20 weeks, and huge fibroids of >20 weeks were \nencountered in 9cases of the study.  \n \nType of fibroid \nAll the leiomyomata were corporeal , no extra uterine fibroid \nwere encountered. Among the uterine about 93.9% were in the \nbody & 6.1% were cervical, intramural fibroid were the \ncommonest variety comprisi ng about 60.6% of the cases, 9.1% \nsubmucous, 5.1% were broad ligament fibroids, all were pseudo \nbroad ligament fibroids 15.2% of the patients had multiple \nfibroid. \n \nType of endometrium \nHistopathology report showed proliferative endometrial in 66 \ncases, secretary changes were noted in 12 patients, endometrial \nhyperplasia was seen in 5 cases, cystic glandular hypertrophy \nwas seen in 3 cases, atrophic endometrial occurred in 8 patients. \nThe results were inconclusive in 6 patients. \n \nTable 1: Different symptoms seen in the present study \n \nDifferent symptoms No. of cases \nDysmenorrhea 10 \nMass in abdomen 6 \nUrinary symptoms 8 \nAsymptomatic 1 \nMenstrual distribution 38 \nWhite discharge 6 \nAbdominal pain 16 \nVaginal mass 1 \nBowel disturbances 0 \nInfertility 8 \nOthers 6 \nTotal 100 \n \nTable 2: Various incidences of various types of Leiomyomas \n \nType of fibroid No. of cases \nIntramural 60 \nBroad ligament 4 \nMultiple 16 \nSubserous 4 \nSubmucous 8 \nCervical 8 \n \nTable 3: Different histopathological pattern of endometrium \n \nHistopathology pattern No. of cases \nSecretory 12 \nGlandular hyperplasia 3 \nSimple hyperplasia 5 \nProliferative 66 \nAtrophic 8 \nunknown 6 \n \nDiscussion  \nThe major gynaecological surgery done throughout the world is \nhysterectomy. Charles Clay was the first to pe rform subtotal and \n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 140 ~ \ntotal hysterectomy in Manchester, England in 1843 and 1929 \nrespectively. It is a successful procedure done in terms of \nsymptom relief, patient satisfaction and definitive cure in much \ndisease [9]. Benign conditions like leiomyoma, dysfun ction \nuterine bleeding, adenomyosis, pelvis inflammatory disease, \nendometriosis, pelvic organ prolapse which account for major \nhysterectomies and rest for malignancy. Of these benign lesions, \nleiomyoma followed by adenomyosis are the commonest \nindication for hysterectomy [10, 11]. \nDespite being the most common tumor, the etiology still remains \na speculation. Genetic and hormonal factors have been \nimplicated. Although estrogen, growth hormone, and possibly \nhuman placental lactogen have been implicated, the r ole of \nestrogen in their growth is significant. Studies using glucose -6-\nphosphate dehydrogenase isoenzyme suggest that each fibroid \napparently arises from a single cell within the myometrium [12]. \nThe incidence of leiomyoma is highest in the 3rd decade, th is is \nsimilar to the incidence quoted by other investigators, like Usha \net al . 1992, indicating that Leiomyoma is a disease seen in \nwomen of child bearing age, they are rarely found before \npuberty, and cease to grow after menopause. About 60% were \nintramural fibroids, which is the most common variety. Similar \nresults were obtain by other authors like Usha et al . (77%). \nChhabra et al. (47%) and Shaw (73%). About 15% of the cases \nhad multiple fibroids in our series. Though the incidence of \ncervical fibroid ha s been coated as very low, 4% (Shaw), 0.6% \n(Tiltman) [13], the incidence our study is comparatively high 6%. \nThe histological pattern of endometrium observed was \nproliferative type in 66 cases, these results are comparable to \nthat quoted by other authors l ike, Madhu Udawat (68%)  [14], \nChhabra et al. (40%). This indicates the hyper estrogenic states \nassociated with fibroids, endometrial was secretory in 12% of \nthe cases. \n \nConclusion  \nLeiomyoma is the most common benign tumor of the pelvis. The \ntrends in the age incidence have remained the same, the \noccurrence of fibroid is rare before 20 years of age, and they \ncease to grow after menopause, thereby commonly affecting \nwomen of child bearing age, most common in third decade. \nThough fibroid is a disease of low parity, it was most commonly \nseen in multipara, a significantly long period of interval \nfollowing last child birth predisposed to the development of the \nfibroids. \n \nReferences \n1. Dayal S, Nagrath A . Clinicopathological correlation of \nendometrial, myometrial and  ovarian pathologies with \nsecondary changes in leiomyoma. Journal of Pathology of \nNepal. 2016;6:937-41. \n2. Gull B, Karlsson B, Milsom I, Granberg S . Factors \nassociated with endometrial thickness and uterine size in a \nrandom sample of postmenopausal women. Ult rasound in \nObstetrics and Gynecology. 2001;18:P03-P. \n3. Witherspoon T . 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International journal of gynecological pathology: \nofficial journal of the International Society of \nGynecological Pathologists. 1998;17:231-4. \n14. Khyade RL . A study of menstrual disturbance in cases of \nfibroid uterus. International Journal of Reproduction, \nContraception, Obstetrics and Gynecology. 2017;6:2494-8.","source_license":"CC0","license_restricted":false}