- 5/15/2025
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00:00hello everyone here we are going to discuss important topic that is leomyoma uterine leomyoma
00:06also known as uterine fibroids in university exam you usually get a short question on that either
00:10on its etiology types gross microscopy or clinical features so it's a small topic yet very commonly
00:16asked in university exams tumors of myometrium one of the important tumor of myometrium we are
00:26discussing that is leomyoma also known as fibroid more commonly it is known as uterine fibroid so we
00:31will understand the topic under following headings first i will let you know the introduction what do
00:35you mean by leomyoma what is leo mama where does it occur then the age of its presentation then its
00:40etiology its type the three types gross microscopy and clinical features so you always write your
00:45answer under the headings in your university exam i always understood okay so before coming on these
00:50topics please understand the three layers of the uterus in the female reproductive system there is
00:55uterus uterus is the organ there are three layers in the uterus the innermost layer is known as
00:59endometrium can you appreciate this one is endometrium the innermost one the middle one is the myometrium
01:04can you appreciate the thicker the most thickest the middle layer this one the thickest layer is the
01:10myometrium this one is the myometrium and the outermost one is the perimetrium the outermost one this
01:15one is the perimetrium these are the three layers you can appreciate the three layers here also
01:19can you see the three layers here please appreciate the three layers so of the uterus
01:24this is endometrium you can see this is perimetrium and this is myometrium the thickest one is the
01:29myometrium see it again see the thickness of the myometrium now i am teaching you leomyoma so
01:34leomyoma is a tumor of which it is not a tumor of endometrium it is not a tumor of perimetrium
01:38it is a tumor of myometrium so leomyomas let's start the topic leomyoma it is the
01:44most common uterine tumor it occurs in the myometrium that's why they arise from the
01:49smooth muscle origin because they are present in the myometrium please appreciate they are present
01:53in the myometrium not in endometrium not in perimetrium they are present in myometrium they
01:58are totally benign they are never malignant rarely they can convert into malignancy then it is known
02:04as leomyosarcoma but leomyoma is malignant once it converted into malignancy rare of the rarest it is
02:10known as leomyosarcoma but usually it is benign they are also known as fibroid so you can get a
02:15question on fibroid so you must understand fibroid is the other name given to leomyoma only most common
02:20age is the reproductive age group what is the reproductive age group in a female from menage
02:25till menopause so menage is 15 years menopause is 45 years or 30 years is age of reproduction so
02:31reproductive age years only it occurs so it never occurs before the age of 15 or 20 and it never occurs
02:37after menopause after menopause if they are already there they will regress in size so it represents
02:42that the most common etiology is the estrogen estrogen is required for their proliferation for
02:48their proliferation what is required estrogen now this is the life of a female in the female this is
02:54the birth of a female this is the death of a female this is menage what does menage menage is the start
03:00of menstruation which occurs at 15 years usually and what is menopause this is menopause menopause is
03:06a stoppage of menstruation that usually occurs at 45 to 50 years so this is the 30 years of
03:11productivity in the life of a female this is the reproductive age group where the menage and menopause
03:16between the menage and menopause the ovaries are activated and estrogen is present and i am saying
03:21for leomyoma for fibroid the estrogen is required so it means that the fibroid or leomyoma occurs in
03:28the reproductive age group they never occur before that and after that they never occur but if they are
03:32already present in this group after menopause they they regress in size they shrink in size because
03:37here estrogen is not present ovaries are shrinking that's why so the estrogen is required for their
03:43proliferation what is the evidence is that estrogen is required so we have seen that it increases in
03:48size and pregnancy during pregnancy what happens imagine a female a female is already having a fibroid in
03:53the uterus and she becomes pregnant the female is already having a fibroid in the uterus it says
03:58symptomatic and during pregnancy during pregnancy it increases in size because during pregnancy there
04:04is more estrogen in the blood more estrogen that is causing increase in size or high dose of estrogen
04:09therapy if the if some female is given external estrogen the fibroid increases in size or after
04:14menopause or after removal of the ovary it regresses in size so this proves that estrogen is required for
04:20its proliferation that is etiology so see the introduction see the age see the etiology now coming on the types
04:26there are three types what do you mean by that now in the diagram of the uterus what are the three
04:32layers of the uterus innermost is endometrium then the middle is the myometrium and outermost is the
04:37parametrium we will draw the three layers let me draw the three layers here for you so here
04:41i'm drawing the endometrium okay so this one is endometrium endometrial lining now i'm drawing the
04:48thickest layer that is myometrium this one is the myometrium and the outermost one is the
04:53the perimetrium let me draw the cirrhosa or the perimetrium this one is the perimetrium now where
04:58is the fibroid what are the three type of the fibroid fibroid can be of three types it can be
05:02inside in the center in the muscle of the myometrium it can be just below the endometrium
05:08or it can be just below the perimetrium just below the cirrhosa cirrhosa as perimetrium so it can be
05:14in the center it can be just below endometrium it can be just below the perimetrium so these are the
05:18three types what do you mean by that what do you mean by that if it is present in the muscle it's
05:23known as intramural intramural means central they are central if they are present just below the
05:29endometrium they are known as submucosal they are just below the mucosa because they are just below
05:34the mucosa that's why submucosal and if they are present just below the perimetrium they are known
05:38as subserosal because they are present just below the serosa so they can be subserosal so they can
05:43be submucosal subserosal and intramural so that is the meaning so the same thing you can see it here
05:48in this diagram also, you can see this one is present in the center. So, this is intramural.
05:55This is also intramural. You can see, okay. Here you can see it is submucosal. It is present just
06:00below the mucosal and it is protruding the mucosal to the lumen. And this one is present
06:03subserosal. It is present just below the serosa and it is protruding the serosa out. So, this one
06:08protrude inside the lumen, the cavity, this one protrude out and this one present in the center
06:12thickening the wall so that is the three type intramural also known as interstitial
06:18subserosal and submucosal subserosal is just below the serosa and submucosal is just below
06:23the endometrium that is mucosa so that is the three types okay now coming on the gross grossy
06:27they are well circumscribed they are encapsulated they all have a capsule they are multiple
06:33sometime they can be single or multiple grayish white and if you cut them you can see whirling
06:38pattern whirling so highlight the word whirling microscopically also you will appreciate the
06:43whirling can you see these all computer tumor cells the tumor cells are spindle shape the tumor cells
06:48are spindle shape they have spindle shape and they are arranged in world pattern they are arranged in
06:55world pattern so the smooth muscle cells the spindle cells the tumor cells they are forming the world
07:00bundles world bundles are there that's the only microscopy they don't have mitosis if you check
07:06they don't have mitosis if they have mitosis it means it is leomyosarcoma whenever the mitosis is
07:12there it converts into malignancy benign one don't have any atypical mitosis they are absent so how to
07:16draw the diagram how to draw the diagram it's very easy so you have to draw the spindle cells the spindle
07:23cells you have to arrange them in bundles the whirling bundles so they are arranged in world pattern
07:29these all are tumor cells i am drawing the spindle cells i am trying to draw so you have to draw the
07:33multiple world bundles you have to draw their nucleus also so this is their nucleus so this is
07:38the world pattern that's it very easy okay sometime you can get a secondary change it's not compulsory
07:43but sometime you can get so one of the secondary any of the secondary changes can be presented is not
07:48always all of them are present for example in this diagram you can see the high line change at the
07:52center this is high line change you can see the eosinophilic pink color acellular material get
07:58deposited at the center that is high line change instead of highlight change there can be assist there can be
08:03infarction there can be calcification there can be necrosis fatty change or sarcomatous change it can be
08:09any so these are the secondary changes apart from the whirling pattern that's it what are the clinical
08:14features usually leo mamas are completely asymptomatic they are benign they are asymptomatic they don't
08:19present anything many females have it but they don't know it incidentally they are detected and
08:24sometime if they present also 90 percent time they are asymptomatic but if 10 percent time they are
08:29presenting also the presentation is either abnormal bleeding during menstruation or between the
08:33menstruation sometime they compress the bladder you know they compress the bladder and since they
08:38compress the bladder they can produce urinary frequency they can produce infertility in the female
08:43and rare of the rarest very rarely they can convert into malignancy that is known as leomyosarcoma
08:48that's all about it so if leomyoma or fibroid coming in your exam you have to frame your answer
08:54under following headings number one it is the most common benign tumor of the uterus in the female
09:01most common benign uterus tumor age it occurs in reproductive age group so it never occurs before
09:06menage and it regresses after menopause so mostly it occurs in the reproductive age group 15 to 45 years
09:12etiology only one etiology estrogen there are many evidences what are the evidences during pregnancy it
09:18increases in size during external estrogen therapy increases in size and after menopause it decreases in
09:24size or after ovary removal it decreases in size so these are the evidences that proves that estrogen
09:30is required for its proliferation then i told you it's three types what are the three types intramural
09:35submucosal subserosal you can understand and draw the valuable diagram for that grossly i told you
09:41they are world they are multiple they are firm they are encapsulated microscopically you have to draw
09:46the spindle cells which are arranged in world pattern that's it and multiple secondary changes can be
09:52there clinical feature usually they are asymptomatic but if symptomatic the abnormal bleeding can be
09:56there infertility their uh frequency of the urination can be there because they compress the
10:01bladder and sometimes they can convert into malignancy rarely that is leumazer that's all about it
10:06so don't forget to check the short very short questions you don't get long question short or very
10:10short question and mcqs of this topic which are given in the notes at question
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