Leiomyomas

Leiomyomas

Leiomyomas, also known as uterine fibroids, are benign smooth muscle tumors that commonly occur in the uterus. They are the most frequent pelvic tumors in women and are a significant cause of morbidity. This article provides a comprehensive overview of leiomyomas, including their etiology, pathophysiology, clinical presentation, diagnosis, and management.

Etiology

Leiomyomas are thought to arise from a single smooth muscle cell in the myometrium that undergoes a series of genetic mutations. The exact cause of these mutations is not fully understood, but several factors are believed to contribute to the development of leiomyomas:

• Genetic Factors: There is a familial predisposition to leiomyomas, suggesting a genetic component. Specific genetic mutations, such as those in the MED12 gene, have been identified in many leiomyomas.
• Hormonal Influence: Estrogen and progesterone are known to promote the growth of leiomyomas. These tumors often regress after menopause when hormone levels decline.
• Growth Factors: Various growth factors, including transforming growth factor-beta (TGF-β), have been implicated in the proliferation of leiomyomas.

Pathophysiology

Leiomyomas are composed of smooth muscle cells and fibrous connective tissue. They can vary greatly in size, from microscopic to large masses that distort the uterus. Leiomyomas are classified based on their location within the uterus:

• Submucosal: Located just beneath the endometrium, these can protrude into the uterine cavity.
• Intramural: Found within the muscular wall of the uterus, these are the most common type.
• Subserosal: Located on the outer surface of the uterus, these can become pedunculated and extend into the pelvic cavity.

Clinical Presentation

The symptoms of leiomyomas depend on their size, number, and location. Common symptoms include:

• Menorrhagia: Heavy menstrual bleeding is the most common symptom.
• Pelvic Pain and Pressure: Large fibroids can cause a sensation of fullness or pressure in the pelvis.
• Reproductive Issues: Leiomyomas can cause infertility, recurrent miscarriages, or complications during pregnancy.

Diagnosis

The diagnosis of leiomyomas is typically made through a combination of clinical evaluation and imaging studies:

• Pelvic Examination: A bimanual examination may reveal an enlarged, irregularly shaped uterus.
• Ultrasound: Transvaginal ultrasound is the most common imaging modality used to diagnose leiomyomas.
• MRI: Magnetic resonance imaging can provide detailed information about the size and location of fibroids, especially in complex cases.

Management

The management of leiomyomas depends on the severity of symptoms, the size and location of the fibroids, and the patient's desire for future fertility. Treatment options include:

• Medical Management: Medications such as GnRH agonists, oral contraceptives, and progestins can help manage symptoms.
• Surgical Options: Myomectomy and hysterectomy are surgical procedures used to remove fibroids or the entire uterus, respectively.
• Minimally Invasive Procedures: Uterine artery embolization and MRI-guided focused ultrasound are less invasive options that can shrink fibroids.

Also see

• Uterine fibroids
• Myomectomy
• Hysterectomy
• Endometriosis
• Polycystic ovary syndrome

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