Uterine fibroids

Uterine fibroids generally represent a benign condition at any age. For asymptomatic patients and those that elect non-surgical treatment or no treatment at all, annual pelvic examination should suffice to document stability in size and growth. It is currently unknown whether leiomyosarcoma represents de novo growth or malignant transformation from benign uterine fibroids. In several series of symptomatic patients undergoing hysterectomy for presumed fibroids, rates of uterine sarcoma have been quoted to be between 0.13% and 0.29%. In light of the large percentage of patients who have asymptomatic fibroids, the rate of uterine malignancy is probably significantly <1 in 1000. Rapid growth, especially following onset of menopause, requires surgical exploration to exclude malignancy.[72]Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004 Aug;104(2):393-406. http://www.ncbi.nlm.nih.gov/pubmed/15292018?tool=bestpractice.com

Nevertheless, the hallmark of uterine malignancy with the exception of endometrial cancer is rapid uterine growth or de novo development of fibroid-like uterine growth following menopause. Although, even in these cases, the likelihood of leiomyosarcoma remains small, it may be prudent to proceed with additional testing including magnetic resonance imaging and possibly surgical exploration. It is also imperative that interval clinical evaluation in patients with uterine fibroids documents a normal adnexal examination, otherwise additional imaging modalities are recommended to insure an adnexal mass is not misinterpreted as uterine fibroid-associated and hence an ovarian or fallopian tube malignancy missed. Abnormal vaginal bleeding, pain, or urinary or gastrointestinal symptoms require the same attention in patients with known or suspected uterine fibroids as in patients without fibroids.