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A Large Intramural Fibroid Uterus presenting as a Hypogastric mass

Patient was a 40 year old nulliparous female coming from a remote village with h/o infertility, a long standing mass in lower abdomen, feeling of heaviness and on/off constipation.

A smooth firm mass is seen and palpated extending from symphysis pubis to midway between umblicus and xiphisternum (equivalent to 32 weeks pregnancy).

The mass was firm, non tender and mobile with no fluctuation.


A Large Uterine Fibroid


Lower midline incision was put. The mass was apparent without any adhesions immediately after opening the abdomen.

A Large Uterine Fibroid

Uterus was grasped and pulled out of the incision.

A Large Uterine Fibroid

Hysterectomy with B/L Salpingo-Oophorectomy was done. On gross examination, the uterus was distorted and cut section showed multiple Intramural Fibroid nodules.


A Large Uterine Fibroid

Common  Exam Questions Related to Fibroid Uterus

What is the differential diagnosis?
  • Pregnancy
  • Full bladder
  • Haematometra/pyometra
  • Adenomyosis
  • Bicornuate uterus
  • Bilateral tubo-ovarian masses
  • Ectopic pregnancy
  • Pelvic Endometriosis
  • Endometrial carcinoma
  • Uterine sarcoma
  • Ovarian neoplasms

 What are the hormones implicated in growth of a fibroid?
Predominantly oestrogen dependant.
Other hormones implicated: Growth hormone, Human placental lactogen

The use of estrogen agonists is associated with an increased incidence of fibroid tumors, and growth hormone appears to act synergistically with estradiol in affecting the growth of fibroid tumors. Conversely, progesterone appears to inhibit their growth.

What are the management options for treatment of Fibroid uterus?
Asymptomatic women
Observation
Symptomatic women who desire fertility preservation
Nonsurgical treatment or myomectomy
Symptomatic women who do not desire future fertility but wish to preserve the uterus
Nonsurgical treatment or myomectomy, myolysis, or uterine artery embolization
Women who desire fertility preservation and have had a pregnancy complicated by uterine fibroid tumors
Myomectomy
Infertile women with distortion of uterine cavity
Myomectomy
Women with severe symptoms who desire definitive treatment
Hysterectomy


Reference:

http://www.aafp.org/afp/2007/0515/p1503.html