Benign and malignant pathology of the uterus

Vasilios Tanos, V Tanos, Berry KE, K E Berry, Kelsey Elizabeth Berry
Best practice & research. Clinical obstetrics & gynaecology · 2017 · vol. 46 , pp. 12–30 · doi:10.1016/j.bpobgyn.2017.10.004 · PMID:29126743 · W2765714267
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This paper reviews uterine myoma diagnosis, management options including myomectomy versus hysteroscopy, and the increased leiomyosarcoma risk in older women with large fibroids, recommending total hysterectomy for suspected malignancy.

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Abstract

The diagnosis of a uterine myoma size and location can be very precise when a 3D sonograph and knowledge are available. The majority of fibroids are asymptomatic, and expectant management is recommended. In young patients, fibroids cause infertility and in middle-aged women, abnormal uterine bleedings. Laparoscopic myomectomy is the preferred way of surgery for IM and SS fibroids, versus hysteroscopy for SM fibroids. In both cases, the size, number of fibroids and the surgeon's experience determine the limitations of the MIGS. Medical treatments provide only temporary tumor reduction and symptom alleviation. Leiomyosarcoma risk is higher in older women usually carrying fibroids larger than 8 cm. There are no other pathognomonic parameters ruling out a sarcoma. In case of suspected fibroid malignancy, the best treatment option is laparotomy and total hysterectomy. Myomectomy complications can be reduced when MIGS is performed by a surgeon with proper training and experience.

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MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Leiomyoma Leiomyoma Leiomyoma Leiomyoma Leiomyoma Uterine Neoplasms Uterine Neoplasms Uterine Neoplasms Uterine Neoplasms Uterine Neoplasms Age Factors Female Gynecologic Surgical Procedures Hormones Hormones Humans

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