••• Chapter 26^ Benign Disorders of the Upper Genital Tract^263
❍ Do fibroids have hormone receptors on them?
Yes. Estrogen and progesterone receptors are both present on leiomyomas. Leiomyomas actually have a great
concentration of these receptors than either the endometrium or myometrium.
❍ What is the risk of malignant degeneration in a leiomyoma?
Malignant degeneration in a preexisting leiomyoma is extremely rare, and occurs in <0.5%.
❍ What is leiomyomatosis peritonealis disseminata?
A rare condition in which benign leiomyomatous nodules are spread out over the pelvic and abdominal
peritoneum, simulating disseminated carcinoma. This usually occurs in young women and is associated with a
recent pregnancy, estrogen secreting granulosa tumor, or oral contraceptive use.
❍ What are the clinical findings of leiomyoma?
Abnormal uterine bleeding.
Pelvic pain.
Pressure effects (constipation, incontinence).
Infertility.
Spontaneous abortions.
❍ Leiomyomas undergo what types of benign degeneration?
Atrophic, hyaline, cystic, calcification, septic, and carneous (red).
❍ What is the natural history of leiomyomas during pregnancy?
Nearly three-fourths of all leiomyomas do not change size significantly during pregnancy; 5% to 10% undergo
carneous or red degeneration, and may cause severe pain and peritoneal irritation. The larger the leiomyoma, the
greater the risk of premature labor.
❍ What are the options for medical treatment of uterine myomas?
Gonadotropin-releasing hormone (GnRH) agonist with add-back therapy (ie, addition of estrogen-progestin therapy).
GnRH antagonist.
Mifepristone (RU-486).
Danazol.
Raloxifene.
Levonorgestrel-releasing intrauterine device.
❍ What is the incidence of leiomyomas that are clinically apparent?
25% to 50% of women have clinically apparent leiomyomas.
❍ What are the various possible locations of leiomyomas?
Subserosal, submucosal, intramural, pedunculated, interligamentary, and parasitic.
❍ Which location is typically the most symptomatic?
Submucosal.