Clinical and paraclinical study regarding the macro- and microscopic diagnosis of various anatomo-clinical forms of operated uterine fibromyoma

摘要

The research focused on a systematic review of 959 cases operated for uterine fibromyoma (24.8%) from 3859 gynecological surgeries performed over a period of 10 years (2000-2010). Materials and Methods: The important parameters were those related to the general clinical and laboratory data, and especially those focused on the macro- and microscopic histopathological diagnostic methods. Thus, we inserted some details on the methods used for the histopathological examination of surgically removed samples. Results: The age of patients operated for uterine fibromyoma was between 20 and 60 years, with the highest incidence in the 40-50 years group (594 cases - 62.4%). The most frequent anatomo-clinical forms observed were uterine fibromyoma with menometrorrhagia (78.9%), large uterine fibromyoma associated with compression and metrorrhagia (81.1%), uterine fibromyoma with aseptic necrobiosis (33.6%). The other forms showed a reduced frequency. Uterine fibromyoma associated with infertility was found in patients under 40-year-old, their evolution being initially asymptomatic. The incidence of uterine fibromyoma, which degenerated into a leiomyosarcoma, was "0". Discussion: 1/5 of patients operated after the age of 35 years presented with various anatomo-clinical forms of uterine fibromyoma. Several hypotheses are formulated regarding the etiopathogenesis, morphology and embryogenesis of this benign tumor of the myometrium. The estrogen-progestogen hormonal imbalance after this age in correlation with the genetic predisposition lead to the synthesis of various proteins, enzymes, and growth factors, decrease of apoptosis and stimulation of leiomyomatous cells with the development of a large, even gigantic form of fibromyoma, representing the most common form encountered in our study. The medical treatment with progesterone derivatives did not lead to the expected results, radical surgery usually being the final therapeutical approach. Conclusions: Between 31 and 60-year-old, the incidence of operated uterine fibromyoma was 941 cases out of 959 (98.1%). The correlation between the preoperative clinical and laboratory diagnosis, the intra-operative morphological appearance and especially the post-operative histopathological examination was 100%. In all cases of uterine fibromyoma, histopathological examination was and will remain the sovereign exploration for surgical practice in general and for gynecological surgery in particular.