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| Leiomyoma | |
|---|---|
| Name | Leiomyoma |
| Field | Gynecology; Pathology |
| Synonyms | Fibroid; Uterine fibroid (when uterine) |
Leiomyoma is a benign smooth muscle tumor most commonly arising in the uterus but also occurring in the skin, gastrointestinal tract, and vascular structures. It presents across specialties including Obstetrics and Gynecology, Pathology, and Surgery and is relevant to population health programs by institutions such as the World Health Organization and national health services like the National Health Service (England). Clinical recognition, imaging, and histopathology guide management strategies used in centers such as Mayo Clinic, Cleveland Clinic, and academic hospitals affiliated with Harvard Medical School and Johns Hopkins Hospital.
Leiomyomas are monoclonal tumors derived from smooth muscle cells, with uterine leiomyomas (commonly called fibroids) being the prototypical form managed by clinicians in Obstetrics and Gynecology and referenced in clinical guidelines from organizations like the American College of Obstetricians and Gynecologists. Other sites include cutaneous leiomyomas encountered by dermatologists at clinics such as Massachusetts General Hospital and gastrointestinal leiomyomas evaluated by endoscopists at centers like Mount Sinai Health System. Grossly they are well-circumscribed, firm, and vary in size from microscopic nodules to large masses affecting organs and nearby structures; definitive characterization often requires pathology services similar to those at Mayo Clinic Laboratories.
Symptoms depend on tumor location and size. Uterine leiomyomas cause heavy menstrual bleeding and pelvic pressure that lead patients to consult clinicians in settings like Kaiser Permanente or university hospitals at University of California, San Francisco (UCSF), and may present with anemia documented by laboratories using protocols from organizations such as the Centers for Disease Control and Prevention. Cutaneous leiomyomas can cause focal pain and are evaluated in dermatology clinics that reference textbooks produced by publishers like Elsevier; gastrointestinal lesions may present with bleeding and are investigated in endoscopy units at institutions such as Cleveland Clinic.
Pathogenesis involves somatic mutations, chromosomal rearrangements, and dysregulated growth factor signaling. Recurrent genomic alterations described in research from laboratories at National Institutes of Health and universities like Stanford University include MED12 mutations and HMGA2 rearrangements. Hormonal influences—particularly estrogens and progestogens—modulate growth via receptors characterized in studies at institutions such as University of Oxford and University of Cambridge, and involve signaling pathways overlapping with those studied in oncology centers like Memorial Sloan Kettering Cancer Center.
Diagnosis integrates clinical assessment, imaging, and histopathology. Pelvic ultrasound, MRI, and endoscopic visualization are standard modalities used in radiology departments at centers like Johns Hopkins Hospital and Massachusetts General Hospital. Histologic confirmation employs immunohistochemistry panels developed in pathology laboratories at institutions such as Mayo Clinic and University College London Hospitals. Differential diagnosis includes malignant smooth muscle tumors considered in oncology units such as MD Anderson Cancer Center.
Management strategies range from conservative monitoring to medical therapy, minimally invasive interventions, and surgery. Medical options include hormonal therapies informed by trials run at institutions like National Institutes of Health and pharmaceutical research at companies such as Pfizer; procedural options include uterine artery embolization performed in interventional radiology suites at hospitals like Cleveland Clinic and MRI-guided focused ultrasound available at specialized centers affiliated with Brigham and Women's Hospital. Surgical approaches—myomectomy, hysterectomy—are performed in operating theaters at tertiary centers including Mount Sinai Health System and Johns Hopkins Hospital. Reproductive counseling often involves reproductive endocrinology units at clinics like Cornell-Weill Medicine.
Leiomyomas are among the most common benign tumors in women, with prevalence data reported by agencies such as the Centers for Disease Control and Prevention and review syntheses published by groups including the World Health Organization. Risk factors include age, race/ethnicity with higher prevalence reported among people of African ancestry in cohort studies from institutions like Howard University Hospital, reproductive history variables evaluated in longitudinal studies at NHS (United Kingdom), and genetic predispositions investigated at centers such as Broad Institute. Environmental and lifestyle associations have been examined in epidemiologic research conducted by universities like Johns Hopkins University and University of California, Los Angeles (UCLA).
Prognosis is generally favorable given benign histology, but complications can include anemia, infertility, pregnancy-related issues, and rarely sarcomatous transformation considered by specialist teams at MD Anderson Cancer Center and Royal College of Obstetricians and Gynaecologists. Long-term outcomes and quality-of-life impacts have been assessed in trials and cohort studies run through networks such as NIH Clinical Center and academic consortia at University of Pennsylvania and University of Michigan. Management decisions balance symptom burden, reproductive goals, and comorbidities as guided by professional societies including the American College of Obstetricians and Gynecologists.
Category:Tumors