Leiomyoma of the stomach: symptoms, modern methods of treatment. Leiomyoma: causes, signs, treatment Surgical removal of the tumor

Skin leiomyoma is a tumor that arises from smooth muscle cells. In rare cases, leiomyoma becomes malignant. The disease develops more often in men.

Reasons for the development of the disease

The exact reasons for the development of leiomyoma are currently unknown. There is an opinion that this disease is associated with a developmental defect and is not neoplasm (newly formed tissue). Cases of familial leiomyoma have been described, that is, the hereditary factor plays an important role in the development of the disease.

Forms of the disease

Depending on the histogenesis, three types of cutaneous leiomyoma are distinguished:

1. First type. These are multiple tumors that develop from levator pili smooth muscle or diagonal muscle.
2. The second type of disease is genital leiomyomas. These are, as a rule, single tumors developing from the smooth muscle fibers of the scrotum or nipples.
3. The third type of disease (angioleiomyoma) develops from the smooth muscle fibers of the vascular walls.

Clinical picture

The main symptom of skin leiomyoma is the appearance of a spherical dense nodule. The size of the knot can vary from the size of a millet grain to a walnut. The color of the neoplasm with leiomyoma is reddish, brown or bluish.

A characteristic feature of leiomyoma is that the neoplasms are sharply painful when exposed to influence (scratching, rubbing with clothing, squeezing, etc.). The pain occurs due to compression of the nerve endings by the tumor.

Intense pain with leiomyoma can be accompanied by such general reactions as decreased blood pressure, constriction of the pupils, and pale skin.

Clinical manifestations of type 1 disease

Skin leiomyomas of the first type are usually multiple. Tumors are located on the neck, face, skin of the trunk and limbs. Tumors often form in groups.

Histological examination of leiomyoma reveals a complex interweaving of smooth muscle fibers. The bundles are separated by layers of connective tissue. The cell nuclei are hyperchromic, the number of nerve fibers is increased, and the number of blood vessels, on the contrary, is reduced.

The tumor in type 1 leiomyoma is clearly limited from the surrounding dermal tissue. In the surrounding tissues, minor swelling and signs of degenerative changes may be observed.

Clinical manifestations of the second type of disease

Genital leiomyoma is a single brown-red nodule the size of a large cherry. The tumor is usually painless. The histological picture is similar to type 1 leiomyoma.

Clinical manifestations of the third type of disease

Angioleiomyoma is a single tumor that slightly protrudes above the surface of the skin. The skin over the tumor can be either unchanged or red-bluish. When palpating the neoplasm, pain is felt.

Several individual tumor elements may form in a small area. Angioleiomyoma is localized, most often, on the extremities, near the joints.

Angioleiomyoma has a specific histological picture. The neoplasm consists of a complex interweaving of thin and short bundles of muscle fibers, which can be arranged randomly or in the form of concentric swirls. In tumor tissues, many cells with elongated nuclei are observed.

The tissues contain many vessels, the membrane of which directly passes into the tumor. In this regard, the lumen of the vessels has the appearance of a gap.

Diagnostic methods

Diagnosis of leiomyoma is carried out by studying the clinical picture. To confirm the diagnosis, a histological examination is necessary.

It is necessary to differentiate leiomyoma from glomus tumor and other tumor pathologies of the skin. To do this, a cold test is performed; after exposure to cold, the leiomyoma temporarily shrinks in size. When subjected to mechanical stress, “goose bumps” are formed on the skin covering the leiomyoma.

Treatment

To treat leiomyoma, radical methods are used - surgical excision or removal of the tumor using coagulation.

Surgical excision is used for large leiomyomas. The operation is performed under local anesthesia and leaves a small scar on the skin.

Thermo- and diathermocoagulation. With these methods, the tumor is destroyed by exposure to high temperature through the use of electric current. The method is bloodless; after its application, a pigmented spot or small scar remains.

Laser destruction. When using this method, the tumor is destroyed under the action of a laser beam, that is, under the influence of light. Such operations are usually well tolerated by patients.

Cryodestruction using liquid nitrogen. The tumor is destroyed by cold. This treatment is effective in the initial stages of cutaneous leiomyoma.

In case of multiple leiomyomas, calcium antagonist drugs such as Verapomil, Nifedipine, Diltiazem can be prescribed to relieve pain.

Treatment with traditional methods

The most effective treatment for leiomyoma is surgical removal. But if the operation is not carried out for some reason, folk remedies can be used.

Celandine ointment for the treatment of leiomyoma. You need to take the whole plant (with roots and leaves) and squeeze the juice out of it. For one part of juice, take four parts of Vaseline or baby cream. Mix well. Apply to the tumor twice a day.

Compresses from golden mustache juice. The golden mustache plant can help in the treatment of leiomyoma. Juice should be prepared from the stems and leaves and used for compresses on the tumor. Bandages should be changed once a day.

Treatment of leiomyoma with plantain. It is necessary to collect plantain leaves, mash them and apply them to the tumor. Secure the compress with a bandage. In winter, when it is difficult to get fresh plantain, you can prepare a steam from dry herbs. Leaves steamed in boiling water should be placed on a piece of bandage and applied to the tumor for leiomyoma. Keep the compress for a day, then prepare a new one. For treatment, plantain should be used that grows away from roadways.

For oral administration in the treatment of leiomyoma, it is recommended to prepare beet juice. Freshly prepared juice should be placed in the refrigerator for at least three hours. After this, treatment for leiomyoma can begin. You should drink 500 ml of juice per day, dividing this amount into 10 servings.

Prognosis and prevention

Prevention of the development of leiomyoma has not been developed. The only possible measure is to carefully monitor the condition of the skin and immediately consult a doctor if tumor-like formations appear.

The prognosis for single leiomyomas is favorable, and for multiple tumors it is relatively favorable. Sometimes leiomyoma becomes malignant, degenerating into leiomyosarcoma.

Macroscopically, Leiomyoma has the appearance of a clearly demarcated node of different sizes, dense consistency, grayish-pink or whitish color when cut. Microscopically, Leiomyoma consists of spindle-shaped cells (Figure 1) with rod-shaped or vesicular nuclei and acidophilic cytoplasm; the cells form bundles intertwining in different directions. Sometimes leiomyoma has a large number of thin-walled vessels around which tumor cells are located. Such tumors are called angioleiomyomas. In long-existing leiomyomas, the number of collagen fibers increases, hyalinosis of the stroma and vessel walls is observed - the tumor acquires the structure of fibromyoma (see full body of knowledge).

Clinical manifestations of Leiomyoma depend on the size of the tumor and its location. Treatment is surgical. Relapses and malignancy of Leiomyoma are rare. With malignancy, malignant Leiomyoma develops (see full body of knowledge Leiomyosarcoma).

Leiomyoma of the skin (synonyms dermatomyoma) is a benign tumor that develops from the smooth muscle elements of the skin. It occurs more often in young and middle-aged men. There are multiple skin leiomyomas, the number of which sometimes reaches several hundred, developing from the smooth muscles of the skin; solitary, or dartoid, Leiomyoma of the skin of the genital organs and smooth muscles of the nipple of the mammary gland; vascular Leiomyoma, developing from the muscular lining of skin vessels.

Macroscopically, skin Leiomyomas have the form of nodules and nodes of a pinkish color, with a diameter of 1-3 cm (dartoid Leiomyomas can reach 4-5 cm in diameter). Leiomyomas that are multiple and develop from small vessels often affect the skin of the upper extremities; Leiomyoma, emanating from the closing arteries, is the skin of the lower extremities with a favorite localization in the area of ​​​​the joints of the leg and foot. Microscopically, skin leiomyomas are built from bundles of smooth muscle fibers intertwined in different directions (Figure 2). In dartoid tumors, the muscle fibers are thickened and separated by uneven layers of fibrous tissue containing small vessels. Vascular leiomyoma of the skin is characterized by a large number of different-sized vessels, resembling arteries and veins, or small vessels in the form of slits with vaguely defined muscle walls that directly pass into the tumor tissue.

Clinically, the picture is characterized by pain on palpation and sensitivity of the tumor to a decrease in ambient temperature. The diagnosis of skin leiomyoma is made on the basis of clinical and pathohistological data. Treatment for skin leiomyoma is excision of the tumor within healthy tissue. The prognosis is favorable.

Relapses after surgery are extremely rare.

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Leiomyoma- benign tumor of smooth muscle cells.

Epidemiology

Classification

Etiology and pathogenesis of leiomyoma

In multiple leiomyomas with an autosomal dominant mode of inheritance, an association with certain HLA-B8 haplotypes was found.

Clinical signs and symptoms

Solitary leiomyoma has the same appearance, but the elements are much larger.

Differential diagnosis

General principles of treatment of leiomyomas

Forecast

A disease called uterine fibroids is very common. The emergence of pathology is facilitated by many unfavorable factors that women have to face in modern life. Infertility can be a serious complication. Uterine fibroids, fibroids, leiomyomas are varieties of the same tumor that differ from each other in structure, but can lead to equally severe consequences. It is important to detect and eliminate pathology in a timely manner.

Content:

Features of leiomyoma

Benign tumors of the uterus (fibroids) form in the wall of the uterus. In addition to muscle fibers, there is also a connective tissue base, as well as a network of blood vessels. Depending on the structure of the tumors, several types of such pathology are distinguished. For example, fibroma consists of fibrous (connective) tissue, fibromyoma is a mixture of fibrous and muscle tissue with a predominance of the former. Leiomyoma is a tumor consisting almost entirely of smooth muscle fibers with a small admixture of fibrous tissue, having a vascular system.

It is a ball that forms in the thickness of the wall, and then grows towards the uterine cavity or extends beyond its limits. Leiomyoma occurs mainly in women of reproductive age (20-40 years), as it is an estrogen-dependent tumor. The peculiarity is that in some cases it can disappear on its own.

Stages of development and forms of existence

The development of leiomyoma occurs in stages.

At the first stage, its rudiment is formed. Subsequent cell division leads to the gradual formation of a tumor node.

At the second stage, the leiomyoma continues to grow due to improved nutrition, as the network of blood vessels grows.

The third stage is regression, the reverse development of uterine leiomyoma, which occurs if the estrogen content in the body drops sharply. This happens, for example, during menopause, when a small leiomyoma that formed earlier resolves on its own after the ovaries stop functioning. Timely treatment for tumor formation in a young woman leads to the same result. In this case, small leiomyomas disappear after artificially reducing estrogen levels with the help of special drugs.

The tumor can exist in nodular (the most common) and diffuse form. The nodular form is characterized by the formation of one (single type) or several (multiple type) rounded nodes with clear boundaries. With the diffuse form, numerous shapeless thickenings appear, scattered throughout the entire volume of the organ. This form is extremely rare.

Nodes of multiple tumors do not form simultaneously and have different sizes. Along with leiomyoma nodes, similar tumors of another type may be present (fibromyomas, for example).

Types of leiomyoma

The wall of the uterus consists of 3 layers: endometrium (internal, monthly renewed mucous membrane), myometrium (muscular layer) and perimeter (outer serous membrane). Depending on the direction in which the node grows, leiomyomas are divided into the following types:

1. Intramural tumor does not extend beyond the myometrium.
2. Submucosal leiomyoma (submucosal) protrudes into the cavity, occupying more and more of its volume as it grows.
3. The subserous (subperitoneal) grows from the outside, enters the abdominal cavity and quite often connects to the body of the uterus with the help of a thin stalk.

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

Causes of leiomyoma formation

The main reason for the development of uterine leiomyoma is hormonal imbalance. A pathological increase in the concentration of estrogen in the blood occurs in the following cases:

1. The production of the pituitary hormones FSH and LH, which regulate the formation of estrogen and progesterone in the ovaries (the “central” variant of the occurrence of pathology), is disrupted. The cause of disturbances may be endocrine diseases, head injuries, improper cerebral circulation, mental and nervous disorders.
2. There is a failure of the hormone-producing function of the ovaries due to the occurrence of inflammatory or tumor diseases in them, damage to these organs (“ovarian variant”). The appearance of leiomyoma in this case is facilitated by abortions and genital surgeries, as well as non-compliance with the rules of hygiene and protection from sexually transmitted infections.
3. In the uterine cavity, receptors that respond to the effects of estrogen are damaged (the “uterine” version). This occurs during curettage or abdominal trauma.

A factor that provokes excessive accumulation of estrogen in the blood is the use of hormonal drugs with a high content of estrogen, metabolic disorders leading to obesity, and changes in blood composition. The cause of improper metabolism can be a woman’s low physical activity and systematic overeating.

An important role is played by hereditary predisposition to the occurrence of such tumors, as well as the presence of congenital pathologies of the development of the genital organs. The occurrence of leiomyoma is promoted by the presence of vascular diseases, in which the blood supply to various organs is disrupted.

Video: Causes of fibroids, how to prevent its development

Symptoms of leiomyoma

Uterine leiomyoma can develop asymptomatically until it reaches a size of 2-3 cm. The growth of neoplasms leads to painful sensations due to tissue stretching and impaired contractility of the uterus.

Menstrual irregularities appear. Menstruation becomes long and heavy. Without knowing the reason, the woman begins to take hemostatic and painkillers. This helps relieve unpleasant symptoms, and a visit to the doctor is postponed. The regularity of the cycle is gradually disrupted, and blood loss increases.

Signs of bladder dysfunction (cramps, frequent urination) and digestive disorders appear. This occurs due to the compressive effect of the tumor on other pelvic organs.

Due to the increase in the size of the nodes, the woman’s belly begins to grow, like a pregnant woman. It is customary to estimate the size of leiomyoma both in centimeters and in “obstetric weeks”. The size of the abdomen as the tumor enlarges corresponds to its size at a certain week of pregnancy.

Note: An enlarged abdomen due to fibroid growth is sometimes mistaken for a sign of pregnancy. Even the presence of menstruation does not bother you, since spotting also occurs during this period.

What are the possible complications?

The severity of complications depends on the size and location of the leiomyoma. Tumors are most often detected after the size of the nodes increases to 5-6 cm or more.

Depending on the type of tumor

Submucosal Uterine leiomyoma is the most common and significant cause of complications, such as:

1. Menstrual disorders, manifested by prolonged heavy bleeding not only during menstruation, but also between them.
2. Infertility. The tumor interferes with the normal formation of the endometrium, which makes it impossible to retain the embryo in the uterus, as well as the formation of a normal placenta. It may block the cervix or fallopian tubes.
3. Birth of leiomyoma. Under the influence of contractions of the uterine muscles, large fibroids, located near the cervix and having a thin base, can prolapse into the vaginal area.
4. Damage to tumor vessels, leading to dangerous uterine bleeding, the occurrence of an “acute abdomen” and anemia.

Subserous. Disorders of menstrual function do not appear. But complications can be no less severe. Twisting of the thin stalk of such a tumor leads to necrosis of its tissue. Decomposition of a dead tumor in the abdominal cavity causes peritonitis.

The pressure of the nodes on the adjacent pelvic organs leads to disruption of their functioning, compression of blood vessels, inflammation, severe abdominal pain, nausea, and vomiting. Such tumors are more difficult to detect and are often discovered only when complications occur.

Intramural. As the tumor enlarges, the state of the vascular network and the structure of the muscle layer are disrupted. This leads to a decrease in uterine contractility, as a result of which the excretion of menstrual blood takes longer than usual. Blood stagnation in the organ cavity, endometritis and endometriosis may occur.

Dull, constant pain in the abdomen is a characteristic sign of the presence of such a tumor.

Leiomyoma during pregnancy

When large submucosal nodes form in a woman, pregnancy becomes difficult due to disruption of the structure of the uterine mucosa. Excess estrogen, which provokes the formation of a tumor, leads to the appearance of anovulatory cycles, in which the egg does not mature and conception is impossible. The implantation of the embryo in the uterine wall is hampered not only by the immaturity of the endometrium, but also by the increased contractility of the uterus during the formation of submucous fibroids.

If the nodes are small, then pregnancy is possible, but the enlarging tumor interferes with the growth of the fetus and impairs its blood supply and nutrition. Labor may begin several weeks before your due date, and heavy bleeding may occur.

After a neoplasm such as uterine leiomyoma is detected in a pregnant woman, its development is carefully monitored. If it increases so much that it interferes with the growth of the fetus, it is removed (most often after the 16th week of pregnancy). Childbirth is carried out prematurely using cesarean section.

Leiomyoma during menopause

In women over 50 years of age, such a tumor cannot normally form. And even vice versa, a pre-existing node often resolves on its own. However, when endocrine diseases occur, uterine tumors still appear, and the risk of their degeneration into cancer increases significantly, especially in the presence of a diffuse type tumor.

Warning: A woman should immediately contact a gynecologist if she experiences bleeding from the genitals during postmenopause. Sometimes this is vital.

Diagnosis and treatment

When prescribing treatment, the benignity of the neoplasm, the number, size and location of the nodes, as well as the severity of the symptoms are specified.

Survey

If a thickening of the wall and an increase in the size of the uterus is detected, an examination is prescribed with an ultrasound (transvaginal and abdominal), an x-ray of the uterus using a contrast solution (hysterosalpingography). The organ cavity is also examined using an optical device (hysteroscopy is performed). If necessary, a tissue sample is taken from the tumor (biopsy using the laparoscopy method), which makes it possible to exclude oncology and clarify the structure of the fibroid. Additionally, MRI and CT scans and blood tests for hormone levels may be prescribed.

Treatment

Treatment uses both conservative and surgical methods. When choosing a technique, the size and location of uterine leiomyoma nodes are taken into account, as well as the patient’s age and her desire to preserve the functionality of the reproductive organs.

Conservative therapy is used when the tumor size is no more than 12 obstetric weeks and there are no dangerous symptoms of complications. The indication for such treatment is the woman’s intention to have children subsequently.

The level of estrogen in the body is reduced. In this case, oral contraception (COC) is used, which helps regulate the cycle, normalizing the ratio of female sex hormones.

To eliminate the consequences of hyperestrogenism, progestin drugs (duphaston, utrozhestan, pregnin) are prescribed, which suppress the effect of estrogen on uterine tissue. Reducing the production of estrogen is also achieved with the help of drugs that suppress the production of pituitary hormones that stimulate the formation of estrogen in the ovaries (Zoladex).

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

Surgery. Indications for its implementation are the large size of the nodes (more than 3 cm in diameter), the presence of a long stalk, a noticeable increase in the tumor, a reduction in the free volume of the uterus, the presence of severe bleeding and anemia. A contraindication would be the presence of inflammatory and infectious diseases in a woman, as well as vascular pathologies and blood diseases.

To remove a tumor, the most commonly used method is laparoscopy - an operation to remove the tumor through punctures in the abdomen. A more traumatic method is laparotomy - removal of the tumor through an incision above the pubis. It is used in the presence of large fibroids. In some cases, the tumor is removed (myomectomy) through the vagina.

The most gentle methods are UAE (blocking tumor blood vessels) and ultrasound ablation. In case of extensive damage to the uterus, partial or complete removal is performed.

Video: Treatment of uterine fibroids using UAE