cervical leiomyoma
Introduction
Introduction to cervical leiomyomas Cervical leiomyoma is a benign tumor, a relatively common tumor that can sometimes be present in combination with uterine fibroids. Primary cervical leiomyomas are uncommon, and the incidence of cervical fibroids is significantly lower than that of uterine fibroids. The ratio of uterine fibroids to cervical fibroids is 12:1. Cervical leiomyomas are classified into primary and secondary according to the source of tumor tissue. basic knowledge The proportion of sickness: 1.2% Susceptible people: women Mode of infection: non-infectious Complications: abortion, anemia, infertility
Cause
Causes of cervical leiomyomas
(1) Causes of the disease
The primary leiomyomas of the cervix are from the interstitial muscle tissue or vascular muscle tissue. The exact pathogenesis is still under investigation. Clinical and laboratory tests suggest that it may be related to estrogen, rare before puberty, childbearing age. More common, most of the fibroids shrink after menopause, the content of estrogen receptor and estrogen in fibroid tissue is higher than normal muscle tissue, estrogen has the effect of promoting cervical smooth muscle tissue hyperplasia and hypertrophy.
(two) pathogenesis
According to the occurrence of fibroids on the cervix can be divided into four types: the anterior wall, the posterior wall, the lateral wall and the drape type. The drape type refers to the growth of fibroids from the cervical canal, protruding in the vagina, and some like the submucosal muscle. Tumor, so the formation of submucosal cervical fibroids, cervical fibroids located in the lateral wall can grow to the broad ligament, cervical fibroids growing in the posterior wall can grow to the posterior peritoneum, cervical uterine fibroids growing in the anterior wall can be posterior to the bladder Ingrown.
1. The giant fibroids are substantially spherical tumors with smooth surface and pseudo-envelope formation. They have obvious boundaries with the surrounding tissues. The cut surface has a swirling structure, white, with red denaturation, it can be slightly red and soft.
2. The microscopic fibroids consist of smooth muscle fibers that are interdigitated with each other, with varying amounts of fibrous connective tissue.
Prevention
Cervical leiomyoma prevention
Follow-up observation, if the cervical fibroids are small and asymptomatic, especially for menopausal patients without treatment, postmenopausal fibroids can naturally shrink, every 3 to 6 months of follow-up, pay attention to the presence or absence of symptoms, and regular gynecology Inspection and B-ultrasound inspection.
Complication
Cervical leiomyoma complications Complications, abortion, anemia, infertility
Secondary infection, cervical tube obstruction affects sperm ups and leads to infertility. 25% to 30% of patients with fibroids are associated with infertility.
In early pregnancy, abortion can be caused by fibroids, the incidence of abnormal fetal position is high, and placenta previa or placental abruption occurs more frequently.
After labor, the uterus is weak, leading to prolonged labor and even delayed labor. Blocking the birth canal causes dystocia.
Long-term bleeding leads to anemia.
Symptom
Cervical leiomyomas symptoms Common symptoms Menstrual blood volume Menstrual volume more vaginal discharge increased vaginal irregular bleeding urinary dysuria urinary pain endometrial obstruction urinary frequency rush after re-discharge difficult
1. Cervical fibroids are often asymptomatic, but are accidentally discovered during other gynecological examinations.
2. Vaginal bleeding patients with cervical submucosal fibroids often have irregular vaginal bleeding, the amount is more or less, menstrual period is characterized by menorrhagia.
3. Increased vaginal secretions Suspended cervical fibroids can show increased vaginal discharge, yellow watery or bloody, and odor if there is secondary infection.
4. Compression symptoms fibroids push the uterine bladder lacuna and the top of the bladder upwards, squeezing the bladder, causing the bladder triangle to twist and tilt, even the ureteral displacement, bladder circulation disorder, resulting in bladder wall congestion, mucosal edema, etc., patients have frequent urination, Urinary pain, urinary retention, poor urination and other symptoms, if combined infection can occur cystitis, fibroids compress the lower end of the ureter or shift the bladder triangle, can cause ureteral obstruction and cause ureteral hydrops, hydronephrosis, pyelonephritis, etc. .
Rectal compression symptoms are less common, but if the fibroids are filled with small pelvic cavity and associated with adhesions, it can cause constipation, difficulty in defecation, and urgency.
Occasionally, cervical fibroids can be used to compress the spinal nerves at the pelvic floor, causing pain in the lower extremities, sciatica, etc. Large cervical fibroids block the cervical canal, resulting in difficulty in menstrual discharge, formation of uterine hemorrhage, and fallopian tube blood.
5. Abdominal uterine fibroids occupy the entire pelvic cavity, the uterus can be pushed to the abdominal cavity, and the patient sometimes touches the hard mass in the abdomen, and the activity is poor.
Examine
Examination of cervical leiomyomas
Vaginal secretions, hormone levels, and tumor markers.
B-ultrasound: It can be seen that the middle and lower echoes of the cervix occupy a substantial position, the boundary is clear, the blood supply is not abundant, and the neck line moves forward or backward.
Cervical biopsy: Cell proliferation is active, and the number of cells above moderate is over. Multinuclear splitting increased the atypicality of 10/10HPF and diffuse moderate to severe nucleus.
Intrauterine exploration: Exploring the length and direction of the uterine cavity can generally be accurately diagnosed.
Colposcopy, hysteroscopy, laparoscopy.
Hysterosalpingography: The number and size of submucosal fibroids can be displayed and can be located. Therefore, it is very helpful for the early diagnosis of submucosal fibroids. Vaginal secretions, hormone levels, tumor markers.
Diagnosis
Diagnosis and differentiation of cervical leiomyoma
diagnosis
Cervical leiomyomas usually grow slowly, and most patients have no obvious symptoms. They are only found during gynecological examinations. Gynecological examination shows that the anterior or posterior lip of the cervix disappears, and the shape of the cervix is prominent and the cervix is deformed. When the cervix is larger, the cervical or cervical wall of the fibroid is thicker, and the cervix without fibroids The part is stretched and thinned, and the external cervix is pressed to the side to form a crescent shape with a concave surface facing the side where the fibroids occur; fibroids that grow toward the broad ligament or the posterior peritoneum often prolong the cervix. If it is a drape type of cervical fibroids or fibroids, the corresponding symptoms appear when the surrounding organs are pressed, and it is closely related to the location of the fibroids, the growth rate and the degeneration of the fibroids, combined with cervical deformation and touching the mass, B-mode ultrasound. Imaging examination and biopsy have no difficulty in diagnosis. If the examination is not careful and the consideration is not comprehensive, it may cause misdiagnosis or missed diagnosis.
Differential diagnosis
1. Identification of submucosal fibroids with the uterus The submucosal fibroids of the uterus should be differentiated from the submucosal fibroids of the uterus. According to the history, symptoms, and examination, the cervical mucosa can be differentiated. The pathological examination obtained can be seen in the typical uterine mucosa, and the diagnosis can be made clear.
2. Identification of uterine fibroids Sometimes cervical fibroids occupy the pelvic cavity and push the uterus upwards. It is difficult to identify whether it is a uterine body or a cervical fibroid. If necessary, you can do uterine fallopian tube iodine angiography. Tube extension and high uterine position can be distinguished from uterine fibroids.
3. Identification of chronic uterine inversion from medical history, symptoms and signs can be identified, uterine varus often has a history of postpartum hemorrhage and increased menstrual flow, examination revealed that the turned out uterus protrudes beyond the cervix, and is evenly spread a circle of cervical margin Around the sometimes prominent uterine mucosal surface can be seen in the fallopian tube opening.
4. Different from cervical cancer, there are bloody or purulent leucorrhea in cervical submucosal fibroids. In the case of secondary infection, malodorous discharge is often misdiagnosed as cervical cancer, cervical cancer is irregular, surface cauliflower or ulcer, base Infiltration, unclear outline, and brittle and easy bleeding, biopsy confirmed.
5. The uterine fibroids that are differentiated from the ovarian tumors to the side wall eventually form a broad ligament fibroid, no menstrual changes, and a lumps on the uterus side, and are clinically misdiagnosed as ovarian tumors. Gynecological examination should be performed carefully. Pay attention to the relationship between the mass and the uterus and its activity, combined with B-mode ultrasound examination, if necessary, do uterine cavity exploration, to explore the length and direction of the uterine cavity, generally can be accurately diagnosed.
6. Identification of cervical polyps with cervical polyps After sexual intercourse, bleeding or increased volume, must be differentiated from cervical fibroids, polyp color bright red, tongue-like, soft, and cervical submucosal fibroids pedicle into the cervical canal, spherical Hard quality.
7. Identification of cervical pregnancy with irregular vaginal bleeding, bleeding from less to more, severe shock can occur even life-threatening, B-ultrasound suggests that the embryo can be completely implanted in the cervical canal can be identified.
