Fact-sheet: Uterine leiomyoma


Updated on 09/25/2024 at 11:14 AM

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Definition

Uterine leiomyomas (synonyms: myomas, fibroids) are benign tumors composed primarily of smooth muscle cells arising from the uterine wall (myometrium). Benign tumors, often multiple and of variable size. Very common in women of childbearing age (20-40% of women > 30 years). Growth of these lesions is stimulated by estrogens. They can therefore grow very rapidly during pregnancy. Fibroid size tends to decrease at menopause, and these lesions may even disappear. Uterine fibroids can be classified according to their location using the FIGO classification (see below). Describe fundal, corporeal, or isthmic location. Leiomyoma subtypes: - Hyaline fibrosis: 60% - Edema: 50% - Cystic - Hemorrhage: 10% - Calcifications: 4%

Clinical features

Asymptomatic.
Pelvic heaviness, metrorrhagia, menorrhagia.
Infertility.

Ultrasound

First-line examination (suprapubic and/or endovaginal approach).
Well-defined round or oval nodules.
Homogeneous hypoechoic, regular margins.
Vascularity: central and predominantly peripheral.
Variable appearance: cystic to calcified

CT

Typical leiomyoma: hypodense.
CT has no role in follow-up or characterization.

MRI

MRI indicated if:

  • > 5 myomas
  • Large size
  • Degenerated myoma

Key sequences:

  • Three-plane T2
  • T1 + T1FS

If not typical:

  • Diffusion
  • Dynamic contrast injection
  • Delayed T1 Gado

Decision tree per Thomassin-Naggara:

  • Marked T2 hypointensity = myoma without atypia, hyaline type.
  • Intermediate T2 signal:
    if hemorrhagic T1 hyperintensity (persisting on T1 FatSat) = myoma undergoing necrobiosis.
    If no T1 hyperintensity: assess the ADC: ADC > 1.2 x 10-3: edematous myoma
  • ADC < 1.2 x 10-3: atypical myoma of uncertain prognosis (ADC = 1.0 x 10-3: cellular myoma; if ADC < 0.8 x 10-3: Leiomyosarcoma)
  • Marked T2 hyperintensity: no enhancement: cystic myoma
  • enhancement: myxoid myoma

Management

Varies by case:

  • Laparoscopic myomectomy
  • Vaginal myomectomy
  • Hysteroscopic resection: criteria = submucosal myoma, 5mm
  • Embolization

Classification

FIGO 2011 classification:

  • 0: pedunculated intracavitary
  • 1: submucosal <50% intramural
  • 2: submucosal ≥50% intramural
  • 3: interstitial in contact with the endometrium
  • 4: interstitial
  • 5: subserosal ≥50% intramural
  • 6: subserosal <50% intramural
  • 7: pedunculated subserosal
  • 8: other locations (cervix, tube)
  • 2-5: Hybrid, extending from the submucosa to the serosa

Classification FIGO des fibromes utérins myome

Differential diagnosis

Leiomyosarcoma (ADC < 0.8),
adenomyoma,
fibroma / theca cell tumor of ovary = differential diagnosis of pedunculated subserosal myoma