Leiomyoma: Difference between revisions

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__NOTOC__
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{{Leiomyoma}}
{{SI}}
 
{{CMG}} {{AE}} Your Name
{{CMG}}; {{AE}} {{CZ}} {{SC}}
{{SK}} Synonym 1; Synonym 2; Synonym 3
 
{{SK}}
==Overview==
==Overview==
 
==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
:*[group1]
:*[group2]
:*[group3]
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
==Pathophysiology==
==Pathophysiology==
===Uterine Leiomyomata===
*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
{{main|Uterine fibroids}}
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
Uterine fibroids are leiomyomata of the [[uterus|uterine]] smooth muscle. As other leiomyomata, they are [[benign]], but may lead to excessive menstrual bleeding ([[menorrhagia]]), often cause [[anemia]] and may lead to [[infertility]]. Enucleation is removal of fibroids without removing the uterus ([[hysterectomy]]), which is also commonly performed. [[Laser]] surgery (called myolysis) is increasingly used, and provides a viable alternative to surgery.
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
 
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Uterine leiomyomas originate in the [[myometrium]] and are classified by location:  
==Causes==
*Sub[[mucosal]] – lie just beneath the [[endometrium]].
* [Disease name] may be caused by either [cause1], [cause2], or cause3].
*[[wiktionary:Intramural|Intramural]] – lie within the uterine wall.
* [Disease name] is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
*Sub[[serous]] – lies at the serosal surface of the uterus or may bulge out from the [[myometrium]] and can become pedunculated.
* There are no established causes for [disease name].
 
==Differentiating [disease name] from other Diseases==
Estrogen and progesterone usually stimulate their growth, and hormone suppression may hence decrease their size.
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
 
:*[Differential dx1]
===Esophageal===
:*[Differential dx2]
They are also the most common [[benign]] [[esophagus|esophageal]] [[tumour]], though this accounts for less than 1% of esophageal neoplasms. The remainder consists mainly of carcinomas. Although the vast majority of benign esophageal tumors are clinically silent and go undetected, large or strategically located tumors may become symptomatic. <ref name=AMN>{{cite web | author = James C. Chou, MD & Frank G. Gress, MD | title =Benign Esophageal Tumors | work =Esophageal Cancer Overview (Cancer of the Esophagus) | url=http://www.health.am/cr/benign-esophageal-tumors/ | publsiher=Armenian Health Network, Health.am | accessdate=2007-03-21}}</ref>
:*[Differential dx3]
 
==Epidemiology and Demographics==
===Leiomyoma of Jejunum===
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
Leiomyoma is the most common benign tumor of small bowel. Approximately 50% of cases are found in the jejunum, followed by the ileum in 31% of cases. Almost one half of all lesions are less than 5 centimeters. <ref name=ARO>{{cite web | author = By Michael P. Buetow, M.D. | title =Leiomyoma of Jejunum | url=http://www.appliedradiology.com/case/case.asp?ID=88&SubCatID=97&CatID=43&ThreadID= | publsiher=Applied Radiology Online | accessdate=2007-03-21}}</ref>
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
 
===Age===
===Gross Pathology===
*Patients of all age groups may develop [disease name].
 
*[Disease name] is more commonly observed among patients aged [age range] years old.
<gallery>
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
Image:leiomyoma.jpg|Leiomyoma enucleated from a uterus. External surface on left; cut surface on right
===Gender===
Image:leiomyoma2.jpg|A large, solitary leiomyoma in the uterus, distoring the endometrial cavity into a Y shape by splaying and pressing it downwards. <br> (Image courtesy of Ed Uthman, MD)
*[Disease name] affects men and women equally.
</gallery>
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
 
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
 
===Race===
==epidemiology and demographics==
*There is no racial predilection for [disease name].
The disease is 5 times more common in Afro-American females.
*[Disease name] usually affects individuals of the [race 1] race.
 
*[Race 2] individuals are less likely to develop [disease name].
==CT==
==Risk Factors==
'''CT images demonstrate a right broad ligament leiomyoma'''
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
<gallery>
== Natural History, Complications and Prognosis==
Image:
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
 
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
Broad ligament fibroid 001.jpg
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
 
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
Image:
*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is pproximately [#%].
 
== Diagnosis ==
Broad ligament fibroid 002.jpg
===Diagnostic Criteria===
 
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
Image:
:*[criterion 1]
 
:*[criterion 2]
Broad ligament fibroid 003.jpg
:*[criterion 3]
 
:*[criterion 4]
Image:
=== Symptoms ===
 
*[Disease name] is usually asymptomatic.
Broad ligament fibroid 004.jpg
*Symptoms of [disease name] may include the following:
 
:*[symptom 1]
</gallery>
:*[symptom 2]
 
:*[symptom 3]
==MRI==
:*[symptom 4]
*Differential diagnosis at MR imaging includes [[adenomyosis]], solid adnexal mass, focal myometrial contraction, and uterine leiomyosarcoma.
:*[symptom 5]
*Nondegenerated uterine leiomyomas have a typical appearance at MR imaging: well-circumscribed masses of homogeneously decreased signal intensity compared with that of the outer myometrium on T2-weighted images.  
:*[symptom 6]
*Degenerated leiomyomas have variable appearances on T2-weighted images and contrast-enhanced images.
=== Physical Examination ===
 
*Patients with [disease name] usually appear [general appearance].
'''Patient #1: MR images demonstrate large degenerating leiomyomas'''
*Physical examination may be remarkable for:
<gallery>
:*[finding 1]
Image:
:*[finding 2]
 
:*[finding 3]
Degenerating leiomyoma 001.jpg
:*[finding 4]
 
:*[finding 5]
Image:
:*[finding 6]
 
=== Laboratory Findings ===
Degenerating leiomyoma 002.jpg
*There are no specific laboratory findings associated with [disease name].
 
*A [positive/negative] [test name] is diagnostic of [disease name].
Image:
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
 
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Degenerating leiomyoma 003.jpg
===Imaging Findings===
 
*There are no [imaging study] findings associated with [disease name].
Image:
*[Imaging study 1] is the imaging modality of choice for [disease name].
 
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
Degenerating leiomyoma 004.jpg
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
 
=== Other Diagnostic Studies ===
Image:
*[Disease name] may also be diagnosed using [diagnostic study name].
 
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Degenerating leiomyoma 005.jpg
== Treatment ==
 
=== Medical Therapy ===
</gallery>
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
 
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
'''Patient #2: MR images demonstrate a leiomyoma prolapsing into the endometrial canal'''
*[Medical therapy 1] acts by [mechanism of action1].
<gallery>
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Image:
=== Surgery ===
 
*Surgery is the mainstay of therapy for [disease name].
Fibroid prolapsed into endometrial canal 001.jpg
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
 
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Image:
=== Prevention ===
 
*There are no primary preventive measures available for [disease name].
Fibroid prolapsed into endometrial canal 002.jpg
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
*Once diagnosed and successfully treated, patients with [disease name] are followedup every [duration]. Followup testing includes [test 1], [test 2], and [test 3].
</gallery>
==References==
 
{{Reflist|2}}
==ultrasound==
Diagnosis depends on position of the myomas. Traditional transabdominal or transvaginal ultrasonogram can detect large submucosal and transmural myomas. For submucosal myomas saline infusion sonography is the best.
 
==Other Imaging Findings==
===Hysterosalpingogram(HSG)===
'''Hysterosalpingogram(HSG) reveals a submucosal leiomyoma'''
 
<div align="left">
<gallery heights="175" widths="175">
Image:Submucosal-myoma-001.jpg
Image:Submucosal-myoma-002.jpg
</gallery>
</div>
 
==medical therapy==
[[GnRH]] analogues for 3-6 months are used to reduce the size of the myomas. It usually reduce the size by 60% to 70%. But once the medication is stopped the myomas will grow back.
 
==surgery==
[[Myomectomy]] is a choice to remove myomas. It is usually done when the client wants to preserve their fertility. Total Abdominal or Vaginal [[hysterectomy]] with Bilateral Salpingo-oophorectomy is the definitive treatment.
 
{{Soft tissue tumors and sarcomas}}
 
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[[Category:Anatomical pathology]]

Revision as of 14:31, 19 April 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Your Name Synonyms and keywords: Synonym 1; Synonym 2; Synonym 3

Overview

Historical Perspective

  • [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
  • In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
  • In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

  • [Disease name] may be classified according to [classification method] into [number] subtypes/groups:
  • [group1]
  • [group2]
  • [group3]
  • Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

  • The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
  • The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
  • On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Causes

  • [Disease name] may be caused by either [cause1], [cause2], or cause3].
  • [Disease name] is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
  • There are no established causes for [disease name].

Differentiating [disease name] from other Diseases

  • [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
  • [Differential dx1]
  • [Differential dx2]
  • [Differential dx3]

Epidemiology and Demographics

  • The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
  • In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

  • Patients of all age groups may develop [disease name].
  • [Disease name] is more commonly observed among patients aged [age range] years old.
  • [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

  • [Disease name] affects men and women equally.
  • [Gender 1] are more commonly affected with [disease name] than [gender 2].
  • The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

  • There is no racial predilection for [disease name].
  • [Disease name] usually affects individuals of the [race 1] race.
  • [Race 2] individuals are less likely to develop [disease name].

Risk Factors

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is pproximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • [Disease name] is usually asymptomatic.
  • Symptoms of [disease name] may include the following:
  • [symptom 1]
  • [symptom 2]
  • [symptom 3]
  • [symptom 4]
  • [symptom 5]
  • [symptom 6]

Physical Examination

  • Patients with [disease name] usually appear [general appearance].
  • Physical examination may be remarkable for:
  • [finding 1]
  • [finding 2]
  • [finding 3]
  • [finding 4]
  • [finding 5]
  • [finding 6]

Laboratory Findings

  • There are no specific laboratory findings associated with [disease name].
  • A [positive/negative] [test name] is diagnostic of [disease name].
  • An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
  • Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

  • There are no [imaging study] findings associated with [disease name].
  • [Imaging study 1] is the imaging modality of choice for [disease name].
  • On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
  • [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

  • [Disease name] may also be diagnosed using [diagnostic study name].
  • Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

  • There is no treatment for [disease name]; the mainstay of therapy is supportive care.
  • The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
  • [Medical therapy 1] acts by [mechanism of action1].
  • Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

  • Surgery is the mainstay of therapy for [disease name].
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
  • [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

  • There are no primary preventive measures available for [disease name].
  • Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
  • Once diagnosed and successfully treated, patients with [disease name] are followedup every [duration]. Followup testing includes [test 1], [test 2], and [test 3].

References

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