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Uterine fibroids (leiomyomata, singular leiomyoma) are the most common neoplasm in females, and may affect about 25 % of white and 50% of black women during the reproductive years. Fibroids may be removed simply by means of a hysterectomy, but much more favourably by a myomectomy or by uterine artery embolization, which preserve the uterus.

Pathology and histology


Leiomyomas grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white, or tan whorled. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall. Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whirled). These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and mitotically active.

Leiomyomas are estrogen sensitive and have estrogen receptors. They may enlarge rapidly during pregnancy due to increased estrogen levels. As estrogen levels decline with menopause, fibroids tend to regress after menopause. Hormonal therapy is based on these facts.

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