Errors and hyperdiagnosis Leiomioma of soft tissues. Medical encyclopedia - Leiomioma. Patients' age

The disease called "Myoma of the uterus" is very common. The emergence of pathology contributes to many adverse factors with which women have to meet in modern life. An infertility may become a serious complication. Myoma of the uterus, fibromyoma, Leiomioma is a variety of one and the same tumor, which differ from each other by structure, but can lead to equally difficult consequences. It is important to detect and eliminate pathology in a timely manner.

Content:

Features Leiomioma

Benign tumors of uterus (moma) are formed in its wall. In addition to muscle fibers, there is still a connective bowl, as well as a network blood vessels. Depending on the structure of tumors, several types of such pathology distinguish. For example, fibroma consists of fibrous (connective) tissue, fibromyoma - from a mixture of fibrous and muscular with a predominance of the first. Leiomioma is a tumor, almost entirely consisting of smooth muscle fibers with a small admixture of fibrous tissue having a vascular system.

It is a tangle that is formed in the thicker of the wall, and then growing towards the uterine cavity or going beyond its limits. Leiomioma arises mainly in women of reproductive age (20-40 years), since it is an estrogen-dependent tumor. The feature is that it is capable of disappearing independently in some cases.

Stages of development and form of existence

Leiomioma development passes in gradually.

At the first stage, its germ forms. The subsequent division of cells leads to the gradual formation of the tumor node.

In the second stage, the increase in leomyoma continues due to the improvement of nutrition, as the network of blood vessels grows.

The third stage is the regression, the inverse development of the uterine leomyomes, which occurs if the content of estrogen in the body drops sharply. This happens, for example, when climax, when a small leuomioma, formed earlier, is solved independently after the cessation of the functioning of the ovaries. The same result leads to a timely treatment in the formation of a tumor at a young woman. At the same time, the lomiomioma of small size disappears after an artificial decrease in estrogen levels with special drugs.

The tumor can exist in the nodal (most common) and diffuse form. For the nodal form, the formation of one (single type) or several (multiple type) of rounded nodes having clear boundaries. With diffuse form, numerous shapeless thickens appear, scattered throughout the volume of the organ. This form meets extremely rarely.

Multiple tumor nodes are formed rapidly, have different sizes. Along with the leiomyoma nodes, such tumors of another type may be present (fibromomy, for example).

Types of Leiomioma

The uterine wall consists of 3 layers: endometrial (internal, monthly renewing mucous membrane), myometrium (muscle layer) and perimetry (outer serous shell). Depending on how the direction is the exploration of the node, leomiomes are divided into the following types:

The intramural tumor does not go beyond the limits of myometrium.
Submucosic Leiomioma (submembrance) opens into the cavity, occupying with an increase in its increasing volume.
The subseasonal (abnormalist) grows outside, goes into the abdominal cavity and is often combined with the bodies of the uterus with a thin leg.

If the tumor is located close to the peritoneum and has a significant size, it can be detected during the palpation of the abdomen.

The reasons for the formation of leiomioma

The main cause of the development of the meter is a hormonal failure. The pathological increase in the concentration of estrogen in the blood occurs in the following cases:

The production of hormones of PSG pituitary glands and LH governments regulating the formation of estrogen and progesterone in the ovaries ("Central" version of the occurrence of pathology) is disturbed. The cause of violations may be endocrine diseases, head injuries, incorrect brain circulation, mental and nervous disorders.
There is a failure of the hormon-forming ovarian function due to the occurrence of diseases of the inflammatory or tumor nature, damage to these bodies ("ovarian option"). The appearance of Leiomioma in this case contribute to the conduct of abortions and operations on the genital organs, as well as non-compliance with the rules of hygiene and protection against infectious infections.
In the uterine cavity, receptors are damaged to the impact of estrogen ("uteros" option). This happens when performing scraping or in abdominal injuries.

The factor provoking the excess accumulation of estrogen in the blood is the use of hormonal drugs with its large content, metabolic disorder leading to obesity, change in blood composition. The cause of improper exchange can be a small physical activity of a woman and systematic overeating.

An important role is played by hereditary predisposition to the emergence of such tumors, as well as the availability of congenital pathologies development of genital organs. Contributes to the emergence of leomyomes vascular diseasesin which the blood supply to various organs is disturbed.

Video: Causes of Moma, how to prevent its development

The symptoms of the occurrence of Leiomyoma

Leiomioma uterus can develop asymptomatic, until it reaches size 2-3 cm. The growth of neoplasms leads to the appearance of painful sensations due to tensions of the tissues, the contraction of the uterus.

Appear menstrual disorders. Monthly become long and abundant. Not knowing the reasons, the woman begins to take hemostatic and painkillers. It helps to weaken unpleasant manifestations, and the visit to the doctor is postponed. The regularity of the cycle is gradually disturbed, blood loss increases.

Signs of work disorder appear bladder (cutting, rapid urination) and digestive disorders. This is due to the squeezing effect of the tumor on other pelvic organs.

Due to the increase in the size of knots, the belly begins to grow, like a pregnant woman. It is customary to assess the size of Leiomioma both in centimeters and in the "obstetric weeks". The size of the abdomen with an increase in the tumor corresponds to its size at a certain week of pregnancy.

Note: An increase in abdomen because of the growth of myoma is sometimes mistaken for a sign of pregnancy. Do not even confuse the presence of menstruation, since bloody issues There are in this period.

What complications are possible

The severity of complications depends on the size and localization of Leiomioma. Tumors are detected most often after increasing the size of the nodes to 5-6 cm and more.

Depending on the type of tumor

Submucose Leiomioma uterus is the most frequent and tangible reason for complications, such as:

Menstrual disorders manifested by prolonged abundant bleeding not only during menstruation, but also between them.
Infertility. The tumor interferes with the normal formation of endometrial, which makes it impossible to hold the embryo in the uterus, as well as the formation of a normal placenta. It can overlap the neck or uterine tubes.
Birth of Leiomioma. Under the action of cuts of the mother-in-law muscles, a large mioma, located near the neck and having a subtle base, can fall into the vagina region.
Damage to the tumor vessels, leading to dangerous uterine bleeding, the emergence of the state of the "acute abdomen" and anemia.

Subseroic. Menstrual function disorders are not manifested. But complications may be no less severe. The twisting of a thin leg of such a tumor leads to the necrosis of its fabrics. The decomposition of the deceased tumor in abdominal cavity Causes peritonitis.

The pressure of the nodes to the neighboring bodies of the small pelvis leads to a violation of their work, squeezing the vessels, inflammation, occurrence strong pain In the abdomen, nausea, vomiting. Such tumors are more difficult to detect, they often recognize them only when complications appear.

Intramural. With an increase in the tumor, the state of the vascular network and the structure of the muscular layer is disturbed. This leads to a decrease in the contraction of the uterus, as a result of which the removal of menstrual blood occurs longer than the usual. Perhaps the occurrence of bloodstand in the body cavity, the appearance of endometritis and endometriosis.

Stupid constant abdominal pain is characteristic sign The presence of such a tumor.

Leiomioma during pregnancy

When forming a woman's large submucosic nodes, pregnancy occurs is hampered due to the violation of the structure of the mucous membrane. Excess estrogen, provoking the occurrence of the tumor, leads to the appearance of anoint cycles, in which the egg cell does not ripen, the conception is impossible. Fastening the embryo in the wall of the uterus is preventing not only the immaturity of the endometrium, but also the reinforced cuttlecy of the uterus in the formation of submucose misa.

If the nodes are small, then the occurrence of pregnancy is possible, but the increasing tumor prevents the growth of the fetus, it worsens its blood supply and nutrition. Births can begin a few weeks before the deadline, it is possible to appear strong bleeding.

After the detection of a pregnant woman of such a neoplasm, like the uterus Leiomioma, careful observation is undergoing. If it increases so much that it hinders the growth of the fetus, it is removed (most often, after the 16th week of pregnancy). Births are produced ahead of time with the use of cesarean sections.

Leiomioma with Climax

In women older than 50 years, such a tumor can not be formed. And even on the contrary, the previously existed node is often resolved. However, if there is an occurrence endocrine diseases The tumors of the uterus still appear, and the risk of moving them in cancer significantly increases, especially if there is a diffuse type tumor.

A warning: A woman should immediately turn to the gynecologist if during the postmenopause there was bleeding from genitals from the genitals. Sometimes it is vital.

Diagnosis and treatment

When prescribing treatment, the benignness of the neoplasm, the amount, size and localization of the nodes, as well as the severity of the symptoms are specified.

Survey

When the wall seal is detected and an increase in the uterine in size is assigned to a survey with an ultrasound (transvaginal and abdominal), uterine X-ray using a contrast solution (hysterosalpingography). An inspection of the organ cavity is also made using an optical instrument (hysteroscopy is carried out). If necessary, sampling of tumor tissue (biopsy using the laparoscopy method), which makes it possible to exclude oncology, clarify the structure of the Mioma. Additionally, MRI and CT can be appointed, the blood test on the content of hormones.

Treatment

In the treatment, both conservative and surgical method are used. When choosing a technique, the size and location of the uterine leiomiomes, as well as the age of the patient and its desire to preserve the functionality of the reproductive organs are taken into account.

Conservative therapy It is used in the case when the size of the tumor is not more than 12 obstetric weeks, no dangerous symptoms Complications. The testimony for such treatment is the intention of women to give birth to children subsequently.

A decrease in estrogen levels in the body is carried out. At the same time, the means of oral contraception (COC) are used, which help to adjust the cycle, leading to normal the ratio of female sex hormones.

To eliminate the effects of hyperstroyment, gestagenic preparations are prescribed (duphaston, ureasia, pregninnin), which suppress estrogen's effect on the tissue of the uterus. Reducing estrogen production is also achieved by drugs overwhelming pituitary hormones that stimulate the formation of estrogen in ovaries (Zoladex).

To accelerate the process of tumor regression, physiotherapeutic procedures (therapeutic baths, electrophoresis and others) are prescribed.

Surgery. Indications to its conduct are large sizes of nodes (more than 3 cm in diameter), the existence of a long leg, a noticeable increase in the tumor, a reduction in the free volume of the uterus, strong bleeding and anemia. Contraindication will be the presence of inflammatory women and infectious diseases, as well as vascular pathologies and blood diseases.

To remove the tumor, the laparoscopy method is most often used - an operation to eliminate the neoplasm through the bumps in the abdomen. A more traumatic method is laparotomy - removal of a tumor through a cut above the pubic. It is used in the presence of Moma big size. In some cases, the tumor is removed (momectomy) through the vagina.

The most gentle methods are the EMM (blocking of blood vessels of the tumor), ultrasonic ablation. With extensive error, the uterus produces partial or complete removal it.

Video: Treatment of myoma uterus by the method of Ema

(L. cutis; Sin. Dermatomiomomioma) L., localized in the dermis and emanating from muscles, lifting hair, or from muscle elements of vessel walls.

- Leiomioma, a benign tumor of smooth muscle fibers. L. nodes are sharply limited, rounded shapes, often hang on the leg. L. develops in the uterus, gastrointestinal and other organs ...
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Leiomiomoma - an infrequent benign tumor from smooth muscle fibers. Five types of skin leioma are isolated: 1) multiple leiomiomes developing from muscles lifting hair; 2) solitary leyomes from the same muscles; 3) solitary leiomiomes of the genital organs and the nipple of the breast; 4) solitary angioleomiomes arising from the muscles of venous vessels; 5) Leiomiomes with additional mesenchymal elements.

Leiomiomes of muscles raising hair

Multiple leiomiomes of muscleslifting hair are the most frequent type of leomyoma and are characterized by small (from 3-5 mm to 1.5 cm in diameter) with dense dermaous nodules having a rounded or extended shape, a smooth surface, in color do not differ from normal skin, pink or Brown coloring. Elements are grouped or located linearly, their palpation can be painful, pain attacks can be provoked emotional stress and cold. During the attack of pain, some tumors are reduced and pale. Favorite places Localization - proximal sections of extensive surfaces of the limbs, as well as torso, head and neck. Usually arise in the first 20-30 years of life regardless of the floor. Development cases of one family are described. The disease begins with the appearance of a small solitarian nodule, which is gradually increasing in size, and in the future, such secondary nodules appear on another area of \u200b\u200bthe skin. Neighboring tumors can merge, forming a plaque. Spontaneous involution is possible.

Solitary, usually have more large sizes (up to 2 cm in diameter), localized in the area lower extremities and reaches 4 cm in diameter. Rarely they are located on upper limbs, torso and face, although any sections of the skin can be affected. Almost in 50% of cases, the neoplasm is accompanied by soreness.

Macroscopic leiomiomes of muscles raising hair, have the form of small intradermal nodules of the density consistency, movable when palpation. Leather over the usual species. No capsules.

Histologically leiomiomes of muscles raising hair Long, intertwined at the right angle of smooth muscle fibers in a connective tissue stroma. It is characteristic that most muscle fibers are located diagonally to the epidermis. In the dermis between the tumor and the epidermis, many extended blood and lymphatic vessels.

Diagnosis Leiomiomes of muscles lifting, It is established on the basis of a clinical picture and is confirmed histologically. Differential diagnosis is carried out with a siring. Hydrohist. Glomus tumor (helps the detection of reduction after leuomioma touch or the effects of cold).

Leiomio treatment of muscles lifting. In solitar tumors, surgical excision is possible; Intensive pains may be a reason for surgical intervention. After surgical removal of multiple leiomes in the neighborhood, new tumors may appear next to remotely removed

Angioleyomomoma

Angioleyomomoma - a benign tumor, developing from the smooth muscles of the venous wall. Manifests itself with dense subcutaneous nodes that do not have any other clinical features, in addition to pain and sensitivity during palpation. However, pain is not characterized not for all angioleomy, and can also be observed with other tumors, such as Oma spiral, angiolipoma, neurom, glomble tumor.

Angioleyomomoma Usually arises in the field of limbs, first of all the lower, and only sometimes - on the face, torso, the nail bed and in the oral cavity.

Histologically angioleomioma It is characterized by a well-defined dermal node surrounded by a compound cloth. The node contains veins of various caliber with muscle walls. Freaks from the periphery of vessels tangentially departed by smooth muscle fibers. The willanes of the vein is rounded or slit, with a small amount of collagen. In large angioloomiomas, sections of mercinate degeneration are noted. It is assumed that the cases of pleomorphic angilaomyoma, containing pleomorphic cells with atypical nuclei, but without mitosis figures, can correspond to a long existing angilaomyoma with degenerative changes similar to those observed in a long-term existing Schwann.

Immunohistochemically in angioleomy Muscular-specific actin is detected, and the reaction to smooth muscle actin and the desphin is negative. It is ultrastructurally confirmed that the tumor consists of normally formed smooth muscle cells.

Treatment of angiothomy Surgical.

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Leiomioma skin is called tumor neoplasm, arising from smooth muscle cells. In rare cases, Leiomioma acquires a malignant course. The disease is more often developing in men.

Causes of disease development

The exact causes of the development of Leiomioma are currently unknown. There is an opinion that this disease is associated with malformation and is not neoplasm (new fabric). Cases of family leiomioma are described, that is, in the development of the disease, not the last role plays healthy factor.

Forms of the disease

Depending on histogenesis, three types of skin leomyoma are distinguished:

First type. These are multiple tumors that develop from smooth muscles raising hairs, or from diagonal muscles.
The second type of disease is genital leiomiomes. This is usually single tumors, developing from smooth muscle fibers of scrotum or chest nipples.
The third type of disease (angiothomyoma) develops from smooth muscle fibers of vessel walls.

Clinical picture

The friction of clothing on the neoplasms is accompanied by pain.

The main symptom of leomyomes of the skin is the appearance of a spherical dense note. The nodule can vary from the size of the seed grain to walnut. The color of the neoplasm with leiomiome - reddish, brown or shiny.

Characteristic feature Leiomiomes - neoplasms are sharply painful with impact (combing, friction of clothing, squeezing, etc.). Pain occurs due to squeezing the nerve ending tumor.

Intensive pain during leiomiome may be accompanied by such common reactions as a decrease in blood pressure, narrowing of pupils, the pallor of the skin.

Clinical manifestations of the disease of the first type

Leomiomes of the skin of the first type are usually multiple. Tumors are located on the neck, face, skin of the body and limbs. Tumors are often formed by groups.

With histological examination of Leiomioma, the complex interweaving of smooth muscle fibers is found. Bunches are separated by layers from connective tissue. The nucleus of cells is hyperchromic, the number of nerve fibers is increased, and the number of blood vessels, on the contrary, is reduced.

The tumor during the leiomiome of the first type is clearly limited from the surrounding tissues of the dermis. In the surrounding tissues, minor edema and signs of dystrophic changes can be observed.

Clinical manifestations of the disease of the second type

Genital Leiomioma is a single boring knot with a size with large cherry. The tumor is usually painless. Histological picture is similar to the leomyome of the first type.

Clinical manifestations of the disease of the third type

Angioleyoma is a single tumor, rigorously outstanding above the skin. The skin over the tumor can be, both unchanged and red-blue. When palpation, the neoplasm feels soreness.

In a small area, several separate tumor elements may form. Angioleomioma is localized, most often, on the limbs, near the joints.

Angioleyomioma has a specific histological picture. The neoplasm consists of complex weave of thin and short beams of muscle fibers, which can be placed randomly or in the form of concentric twist. In the tumor tissues there are many cells having an elongated kernel.

In the tissues there are many vessels, the shell of which is directly moving into the tumor. In this regard, the lumen of the vessels has the appearance of the gap.

Diagnostic methods

Leiomioma diagnosis is carried out by studying the clinical picture. To confirm the diagnosis, it is necessary to conduct histological research.

It is necessary to differentiate leuomioma from the glomble tumor, and other tumor leather pathologies. To do this, they carry out a cold test, Leiomioma after exposure to cold is temporarily reduced in size. With mechanical exposure on the skin covering leioma, "goose leather" is formed.

Treatment

For treatment, the surgical method is used.

For the treatment of leomiomes, radical methods are used - surgical excision or tumor removal by coagulation.

Surgical excision is used for large leomyomes. The operation is carried out under local anesthesia, after her behavior on the skin there is a small scar.

Thermo and diathermocoagulation. When applying these methods, the tumor is destroyed by exposure high temperatures Due to the impact electric current. The bloodless method, after its use, a pigmented spot or a small rutter remains.

LaserDestruction. When applied this method The tumor is destroyed by the action of the laser beam, that is, under the action of light. Such operations are usually well tolerated by patients.

Cryodestruction with liquid nitrogen. The tumor is destroyed under the influence of the cold. Such treatment is effective on initial stages Skin leuomioma.

With multiple leuiomiomes for removal owl syndrome Preparations can be appointed - calcium antagonists - vegetation, nifedipine, diltiazene.

Treatment by folk methods

Most effective treatment Leiomiomes are removal surgical methods. But if the operation for some reason is not carried out, the use of folk remedies is possible.

Ointment from Cellity for the treatment of Leiomioma. It is necessary to take a whole plant (with roots and leaves) and squeeze juice from it. One part of the juice should take four parts of Vaseline or children's cream. Mix well. Apply on a tumor twice a day.

Compresses from the juice of the Golden Usa. In the treatment of leuomioma, the plant of the golden mustache can help. From the stems and leaves, it is necessary to prepare juice and use it for compresses on the tumor. Changing the dressings follows once a day.

The treatment of Leiomioma by Playground. It is necessary to assemble the plates of the plantain, spread them and attach to the tumor. Compress secure the bandage. In winter, when to get a fresh plantain is difficult, you can prepare a fear of dry grass. Spared in boiling water leaves need to be put on a piece of bandage and applied to the tumor during leiomiome. Keep the compress day, then you should cook new. For treatment, you should use the plantain growing at a distance from passage roads.

For receiving inside in the treatment of Leiomioma, it is recommended to prepare beet juice. Freshly prepared juice should be placed in a refrigerator at least three hours. After that, you can begin the treatment of Leiomioma. On a day, you should drink 500 ml of juice, dividing this amount by 10 servings.

Prediction and prevention

The prevention of the development of Leiomioma is not developed. The only possible measure is attentive observation of the state. skin Pokrov and immediate appeal to the doctor in the appearance of tumor-shaped formations.

The prediction for single Leiomioma is favorable, with multiple tumors - relatively favorable. Sometimes Leiomioma takes a malignant character, reborn in Leiomiosarcoma.

Leiomiomoma - a benign tumor of smooth muscular cells.

Epidemiology

Moiogenic tumors make up about 10% of all soft skin neoplasms. The ratio of smooth muscle tumors and neoplasms from transverse striped muscles 100: 1. Pilyan leiomiomes are about 10% of all leiomic skin. Multiple forms There are much more often than solitary. The ratio of women and men 2: 1, with family cases - 8: 1, with sporadic cases - 5: 1.

Classification

Leiomioma, developing from the muscle lifting hair (Pilyan Leiomioma).
Dartoid, or genital leuomioma, emanating from the smooth muscles of the sheath of the scrotum, women's outdoor genital organs or muscles, compressing the nipple of the mammary glands.
Angioleomioma, developing from muscular elements of small skin vessels.
Modified classification of multiple leaviem skin according to E.I. Fadeeva (2002):
Heredity: hereditary; Sporadic (non-treating);
Clinical option: Multiple isolated, focal, mixed, special forms (by the type of disease Darius, a zosteriform version, by type of neurofibromatosis).

Etiology and pathogenesis Leiomioma

With multiple leiomiomas with an autosomal dominant type of inheritance, a connection was detected with some HLA-B8 haplotypes.

Clinical signs and symptoms

Multiple Leiomioma arises at a young age, characterized by the appearance of small nodules of color of normal skin, pink, red or other shades without subjective sensations. The nodules are increasing in size and quantity. The first elements appear on the limbs, less often - on the back, chest, face. Painses of varying degrees are available from almost all patients, usually an approached nature, a duration of several minutes to 1.5-2 hours.

The solitary Leiomioma has the same kind, but the elements are much larger.

The diagnosis is based on clinical signs and biopsy results.
The tumor node of the Pilyan Leiomioma is clearly deliberate from the surrounding dermis and consists of intertwined thick beams of smooth muscle fibers, between which there are narrow interlayers of the connective tissue. When painting according to the method of Wang-Gizon, muscle bundles are painted in yellow, and connecting tissue - in red. The tumor, developing from diagonal muscles, without clear boundaries, has a similar structure, but the bundles of muscle fibers are somewhat thinner, lie more loose. Between muscle beams in a scant connective tissue is a capillary type vessels, sometimes with focal lymphic histiocyte infiltrates. There may be swelling and dystrophic changes. The presence of a pronounced connecting stroma in painless tumors is likely to be one of the factors that prevent the excessive squeezing of nerve fibers while reducing smooth muscles.
Angioleyomioma consists of a thick weakening of the beams of thin and short fibers, located in places randomly, in places in the form of concentric structures or twists. In the tumor tissue, there are many cells with elongated nuclei, intensively painting hematoxylin and eosin. Among these elements, many vessels are found with a fuzzy muscular shell, directly moving into the tumor tissue, and in connection with which the vessels have the appearance of the gaps located between the bunches of muscle fibers. Depending on the nature of the prevailing vascular structures, 4 main types of angioleoma structure can be distinguished. The most often occurs an angioloomyoma of arterial type, then venous and mixed, as well as unoccalued angilameomes, in which the few vessels are determined, mainly with slobs. In some angioloomiomas, you can see the traits of similarities with the Glomus Angiomas of Barre-Masson. They are characterized by the presence of "epithelioid" cells that make up the bulk of the tumor. In more late time In angio-leuomiomas, various changes in secondary nature can be found in the form of a sharp expansion of the vessels, the growth of the connective tissue, leading to sclerosis, hemorrhage, followed by the formation of hemosiderin.

Differential diagnosis

Neurofibromatosis, Leiomiosarcoma, Nevnoma.

General Principles of Leiomiomic Treatment

Surgical excision are shown, the electricity of the solicitarian element is shown.
For relief pain sensations A-adrenoblasts are shown in combination with calcium channel blockers: nifedipine inside for a long time of 10 mg 3 p / day
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Prazozin inside for a long time of 0.5 mg 3 p / day.

Forecast

With solitar tumors, favorable, with multiple - relatively favorable.