Uterine fibroid causes, symptoms, diagnosis, treatment, pathology

Uterine fibroids, are also called leiomyomas.Leio- means smooth, myo- means muscle, and -oma means tumor, so these are benign smooth muscle tumors of the uterus.In fact, fibroids are the most common type of tumor in females.The uterus is a hollow organ that sits behind the urinary bladder and in front of the rectum.

The top of the uterus above the openings of the fallopian tubes is called the fundus,and the region below the openings is called the uterine body.The uterus tapers down into the uterine isthmus and finally the cervix, which protrudes into the vagina.Zooming into the cervix, there are two openings, a superior opening up top, and an inferior opening down below, both of which have mucus plugs to keep the uterus closed off except during menstruation, and right before ovulation.The uterus is anchored to the sacrum by      uterosacral ligaments, to the anterior body wall by round ligaments, and it’s supported laterally by cardinal ligaments as well as the mesometrium,which is part of the broad ligament.

The wall of the uterus has three layers: the perimetrium, which is a layer continuous with the lining of the peritoneal cavity, the myometrium, which is made of smooth muscle that contracts during childbirth to help push the baby out, and the endometrium, a mucosal layer, that undergoes monthly cyclic changes.Now, uterine fibroids are smooth muscle tumors, and they’re monoclonal, meaning that they arise from a single cell of the myometrium that starts dividing uncontrollably.Overall, fibroids most commonly affect women of African descent.

They’re sometimes linked to a genetic mutation, with the most common being a somatic mutation with the mediator complex subunit 12 or MED12 gene.Mediator complex subunit 12 is part of a group of proteins that control gene activity by regulating how transcription factors bind to RNA polymerase II.Another factor in fibroid development is steroid hormones.Fibroids have a love affair with estrogen and progesterone!Fibroids upregulate their receptors for these two hormones and also produce a lot of aromatase,an enzyme that converts androgens into estrogen.When these hormones bind to the myometrium cells, it has a mitogenic effect, meaning it promotes mitosis.Estrogen specifically upregulates growth factors, like IGF- 1, EGFR, and TGF- beta1, and progesteroneupregulates EGF, TGF- beta1, and TGF- beta3.So, the more estrogen and progesterone available, the more a fibroid is likely to grow.This is why fibroids typically affect premenopausal females and why they grow rapidly during pregnancy 

when there’s a lot of estrogen around.Another risk factor for developing a fibroid is never having a pregnancy and breastfeeding,and having many menstrual cycles - each with a wave of hormones.Finally, a historical risk factor that is less relevant now, was exposure to diethylstilbestrol,an estrogen medication that used to be given to pregnant women.Finally, in rare cases, fibroids are linked to a hereditary condition called renal cell carcinoma syndrome, also called Reed’s syndrome, 

which causes skin and uterine fibroids and an aggressive form of papillary renal cell cancer.Fibroids can be described based on where they are located in the uterus.The most common type are intramural fibroids, and they develops within the wall of the uterus.Subserosal fibroids come from myometrial cells at the perimetrium, and they can actually detach from the uterus and get their blood supply from another nearby organ.Submucosal fibroids come from myometrial cells just below the endometrium and they can grow into the cavity of the uterus and change its shape.When that happens, they’re called pedunculated fibroids.Lastly, cervical fibroids grow in the wall of the cervix.

Uterine fibroids are round, firm, and grayish-white in color and they can range from barely visible lumps to large tumors that can be felt on the outside of the body.Sometimes they are solitary, but they can also develop in groups.They’re benign, so they don’t invade neighboring tissue or spread to other parts of the body.Fibroids are usually small and asymptomatic, but their location, number, and size can sometimes lead to symptoms, like abnormal uterine bleeding, which takes the form of heavy or long menstrual bleeding.Over time this can lead to iron deficiency anemia.Fibroids can also cause abdominal pain, because the fibroids put pressure on pelvic organs.Submucosal and intramural fibroids, in particular, are also associated with infertility and ahigher risk of miscarriage.

In pregnancy, fibroids can also cause issues such as fetal malpresentation, preterm labor,and postpartum hemorrhage.Diagnosis of uterine fibroids is done with a pelvic exam and ultrasound.Rarely, a biopsy of the mass is done to rule out that it’s not a cancerous tumor, called a uterine sarcoma.

If it’s a fibroid, the biopsy will show a whorled pattern of smooth muscles bundles- like a wave in the ocean - with well- defined borders.Treatment of uterine fibroids varies: asymptomatic uterine fibroids are usually left untreated.Symptomatic fibroids can be treated with surgery, either a myomectomy or a hysterectomy, if the woman is no longer interested in childbearing.

Another, non- invasive option is uterine artery embolization, where a catheter is used toreduce blood flow to the fibroids and causes them to shrink.Medications aren’t typically used for treatment, except gonadotropin- releasing hormone analog  which help shrink fibroids before surgery.All right, as a quick recap, uterine fibroids, or leiomyomas, are benign smooth muscle tumors of the uterus, and occur most commonly in women of African descent.

They’re sometimes linked to genetic mutations in smooth muscle cells like in the MED12 gene,but estrogen and progesterone also play a role in their development.Most fibroids are asymptomatic, but some cause abnormal uterine bleeding, pain, and fertility issues.