Clinicopathological Study of Uterine Leiomyomas: A Multicentric Study in Rural Population

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This multicentric study of 100 patients found that uterine leiomyomas commonly present with menstrual disturbances and intramural location, while associated adenomyosis, cystic ovaries, and proliferative endometrium indicate a hyperestrogenic state.

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This multicentric study analyzed the clinicopathological spectrum of uterine leiomyomas in 100 women from rural populations across two Indian medical institutions between 2008 and 2012. The results indicated that intramural fibroids were the most common variety, with menstrual disturbances serving as the primary mode of presentation among patients typically in their third decade of life. Pathological examination revealed a high prevalence of proliferative endometrium and cystic ovaries, alongside adenomyosis in 16% of cases, which the authors interpreted as evidence of an associated hyperestrogenic state. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

BACKGROUND AND OBJECTIVES: Leiomyoma of uterus forms the most common type of benign tumor of uterus and also the most common pelvic tumor in women. The symptomatology continues to be variable. Surgery has for long been the main mode of therapy for the myomas. For women who wish to retain the uterus for future pregnancies or other reasons, myomectomy is preferred. Recent trend has been toward nonsurgical approaches like GnRH hormone analogs/agonists, RU 486, or selective uterine artery embolization, laparoscopic cryoablation, radiofrequency thermal ablation, and MRGUs. This multicentric study was an attempt to analyze the clinicopathological spectrum in cases of leiomyoma of the uterus at Cheluvamba Hospital, Adichunchanagiri Institute of Medical Sciences, and to know regarding the pattern of presentation, pathological correlation, with type of fibroid, and endometrial and ovarian changes. METHODS: A clinical study of 100 cases of fibroid uterus was conducted in the Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysore, and Adichunchanagiri Institute of medical sciences, BG Nagara, Mandya from November 2008 to August 2012. The cases are selected by random allocation. On admission, detailed history, clinical examination, and investigations were recorded. RESULTS: Leiomyoma is the most common benign tumor of the uterus and commonly affects the women of child-bearing age, most commonly in the third decade, 55 %. The most common mode of presentation was menstrual disturbances (76 %), among which menorrhagia was seen in 54 % of the cases. Primary infertility was seen in 15 % of the patients. Intramural fibroids were the most common variety occurring in 60 % of the cases. Endometrial pattern was proliferative in 66.3 %. Cystic ovaries were seen in 8 % of the patients, adenomyosis in 16 % indicating hyperestrogenism. CONCLUSION: Fibromyoma (leiomyoma) is the most common benign tumor of the pelvis. It commonly affects the women of child-bearing age, mostly in the third decade and is most commonly seen in multipara. The most common mode of presentation is menstrual disturbances. Intramural fibroid is the most common variety. The proliferative and hyperplastic endometrium was commonly reported. The presence of proliferative endometrium, adenomyosis, and cystic ovaries all are indicative of hyperestrogenic state associated with development of fibroids.
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Abstract

Background and Objectives Leiomyoma of uterus forms the most common type of benign tumor of uterus and also the most common pelvic tumor in women. The symptomatology continues to be variable. Surgery has for long been the main mode of therapy for the myomas. For women who wish to retain the uterus for future pregnancies or other reasons, myomectomy is preferred. Recent trend has been toward nonsurgical approaches like GnRH hormone analogs/agonists, RU 486, or selective uterine artery embolization, laparoscopic cryoablation, radiofrequency thermal ablation, and MRGUs. This multicentric study was an attempt to analyze the clinicopathological spectrum in cases of leiomyoma of the uterus at Cheluvamba Hospital, Adichunchanagiri Institute of Medical Sciences, and to know regarding the pattern of presentation, pathological correlation, with type of fibroid, and endometrial and ovarian changes.

Methods

A clinical study of 100 cases of fibroid uterus was conducted in the Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysore, and Adichunchanagiri Institute of medical sciences, BG Nagara, Mandya from November 2008 to August 2012. The cases are selected by random allocation. On admission, detailed history, clinical examination, and investigations were recorded.

Results

Leiomyoma is the most common benign tumor of the uterus and commonly affects the women of child-bearing age, most commonly in the third decade, 55 %. The most common mode of presentation was menstrual disturbances (76 %), among which menorrhagia was seen in 54 % of the cases. Primary infertility was seen in 15 % of the patients. Intramural fibroids were the most common variety occurring in 60 % of the cases. Endometrial pattern was proliferative in 66.3 %. Cystic ovaries were seen in 8 % of the patients, adenomyosis in 16 % indicating hyperestrogenism.

Conclusion

Fibromyoma (leiomyoma) is the most common benign tumor of the pelvis. It commonly affects the women of child-bearing age, mostly in the third decade and is most commonly seen in multipara. The most common mode of presentation is menstrual disturbances. Intramural fibroid is the most common variety. The proliferative and hyperplastic endometrium was commonly reported. The presence of proliferative endometrium, adenomyosis, and cystic ovaries all are indicative of hyperestrogenic state associated with development of fibroids. Similar content being viewed by others

References

Marshall LM, Spiegelman D, Barbieri RL, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90:967–73. Baird DD, Schectman JM, Dixon D, et al. African Americans at higher risk than whites for uterine fibroids, ultrasound evidence. Am J Epidemiol. 1998;147(11):590. Lumbiganon P, Rugpao S, Phandhu-Fung S, et al. Protective effect of depot medroxyprogesterone acetate on surgically treated uterine leiomyoma a multicentre case-control study. Br Jr Obstet Gynecol. 1995;103(9):909–14. Reinsch RC, Murphy AA, Morales AJ, et al. The effects of RU 486 and leuprolide acetate on uterine artery blood flow in fibroid. A prospective randomized study. Am J Obstet Gynecol. 1994;170(6):1623–8. Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995;346:671–2. Zupi E, Piredda A, Marconi D, et al. Directed laparoscopic cryomyolysis: a possible alternative to myomectomy and/or hysterectomy for symptomatic leiomyomas. Am J Obstet Gynecol. 2004;190(3):639–43. Pansky M, Cowan BD, Frank M, et al. Laparoscopically assisted uterine fibroid cryoablation. Am J Obstet Gynecol. 2009;201(6):57. Bergamini V, Ghezzi F, Cromi A, et al. Laparoscopic radiofrequency thermal ablation: a new approach to symptomatic uterine myomas. Am J Obstet Gynaecol. 2005;192(3):768–73. Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance guided focused ultrasound surgery for uterine myomas 24-month follow-up. Ultrasound Obstet Gynaecol. 2009;34(5):584–9. Al Hilli MM. Stewart EA. Magnetic resonance guided focused ultrasound surgery. Semin Reprod Med. 2010;28(3):242–9. Bhaskar Reddy D. Study of 325 cases of fibromyoma of uterus. J Obstet Gynaecol India. 1963;13:340. Usha, Narang BR, Tiwari PV et al. Clinicopathological study of benign tumors of the uterus. Indian Med Gazette. 1992;12:68–71. Poddar IL. Fibromyoma of uterus. Indian J Obstet Gynaecol. 1957;8:109. Pinto I, Chimeno P, Romo A. et al. Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment—a prospective, randomized, and controlled clinical trial. Radiology. 2003;226(2):425–31. Chhabra S, Ohri N. Leiomyoma of uterus – A clinical study. J Obstet Gynaecol India. 1993;33:438–9. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest Maitri Raghavendra Kulkarni, Indranil Dutta, Dilip Kumar Dutta declare that they have no conflicts of interest. Informed consent All procedure followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study. Additional information Maitri Raghavendra Kulkarni is an Assistant Professor in the Adichunchanagiri Institute of Medical Sciences, Mandya, India; Indranil Dutta is an Assistant Professor in the IQ City Medical College, Durgapur, India; Dilip Kumar Dutta is a Consultant in the GICE Hospital, Kalyani, Nadia, India. Rights and permissions About this article Cite this article Kulkarni, M.R., Dutta, I. & Dutta, D.K. Clinicopathological Study of Uterine Leiomyomas: A Multicentric Study in Rural Population. J Obstet Gynecol India 66 (Suppl 1), 412–416 (2016). https://doi.org/10.1007/s13224-015-0773-y Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s13224-015-0773-y

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