First discovered in 1854 by Rudolf Virchow, leiomyoma are neoplastic growths that originate in the uterus. They can either originate singularly in a patient or can be a result of genetic propensities. Leiomyomas can develop wherever smooth muscle is present:
- Piloleiomyomas: Originate in the pilli muscle
- Angioleiomyomas: Develop in the arteries
- Genital Leiomyomas: Grow on the erectile muscle of the nipple, labia majora, scrotum and also primarily in the uterus and kidney.
Though cases are rare, men can develop leiomyomas.
Risk Factors
Leiomyoma risk factors may include:
- Family History: The hereditary form of leiomyoma was discovered in the late 1850’s by Dr. Kleopfer and was found to be the cause of multiple leiomyomas. Because of genetic predisposition, leiomyomas can make themselves apparent as a dominant autosomal trait. The percentage of genetically pre-disposed women older than 50 is 20-50%.
- Race: The ratio of Black versus White subjects at risk for developing leiomyomas is 3:1.
- Pre-Menopause: Pre-menopausal women are at higher risk for leiomyomas, since these particular fibroids seem to be hormonally dependant; leiomyomas seem to shrink or disappear in some women who are pre-menopausal.
Individuals with multiple leiomyomas are at risk of developing Renal Cell Carcinoma (RCC), which causes cancer of the kidneys. Both chemotherapy and radiation therapy are ineffective in curing this type of cancer.
Outlook
Many leiomyomas can be left untreated if they are monitored properly. Most leiomyomas are small and asymptomatic and seem to shrink after menopause. If diagnosed with a benign leiomyoma, the chances of surgery or other treatment options seem to be avoidable.
Prevention
- Low-Dose Birth Control: Leiomyomas are primarily dependent upon estrogen. Low dose birth control (contains less estrogen) can help reduce high levels of estrogen in the body.
- Tomato Powder Supplement: Theory has it, that tomato powder supplement can aid in the prevention of Leiomyomas.
- Family Awareness: Being privy to ones family history of fibroids is also wise, since some leiomyomas can be caused due to genetics.
Signs & Symptoms
Leiomyomas can exhibit exceptionally painful and cosmetically disfiguring symptoms. If a tumor develops in or around the cervix, it can cause complications with conception, and childbirth.
Pain associated with leiomyomas directly correlates with whether leiomyomas are singular or have developed into a cluster of malignant cells. Asymptomatic leiomyomas tend to have a larger number of mast cells. More painful leiomyomas are solitary, or have fewer mast cells. Another theory suggests that pain is caused by the contraction of the muscle surrounding the tumor, but this conjecture is inconclusive.
Some women have no symptoms associated with their uterine fibroids, while other may experience a host of varying symptoms:
- Uterine Bleeding
- Abnormal Pain
- Constipation
- Frequent Urination
- Menstrual Irregularities
- Severe Menstrual Pain
Diagnosis
The most conventional methods of diagnosis, though sometimes vague, include:
- MRI: Magnetic resonance imaging.
- CT Scan: Computed tomography imaging.
- Laparoscopy: A laparoscopy utilizes a fiber optic camera system to capture images of the ovaries and uterus.
- Histology: The microscopic evaluation of cells removed from the uterus.
- Physical Examination: Your physician may be able to detect a large or abnormally shaped uterus.
STAGING
Leiomyomas are benign tumors, and therefore not classified in stages.
Treatment
If the tumor is asymptomatic and monitored closely, leiomyomas can be left untreated without having any long term debilitating or life-threatening effects on the patient.
Large leiomyomas, however, should be treated promptly. Some treatment options are:
- Hysteroscopy: An outpatient procedure where bulging tumors can be removed whereby a telescope is inserted into the uterus and fibroids are cut out and removed.
- Myomectomy: This surgical procedure leaves the uterus intact and allows for future childbirth. Only the tumors are removed from the uterus.
- Hysterectomy: The surgical removal of the uterus. This procedure is only recommended for women who do not plan on future childbirth and whose fibroids are severe.
