WOMENS-HEALTH Messages for December, 2002: Re: Atypical leimyoma

Re: Atypical leimyoma

From: William McIntosh, MD (anonymous@obgyn.net)
Wed, 18 Dec 2002 08:25:32 -0600 (CST)

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Reply: Sidrah: "Re: Atypical leimyoma"

At Tue, 17 Dec 2002, Sidrah wrote: >
>I am 31 years old, female, married for the last five years. I have
>always had irregular menses and had taken progesterone therapy off and
>on to regularize them, but with out any success. Menstruation cycle
>remained irregular any where between 30-50 days
>We as a couple suffer from male factor infertility (congenitally absent
>Vas Deference) diagnosed only two years ago. On Ultrasound I have
>multiple fibroid uterus.
>We are contemplating fertility treatment in form of ICSI after surgical
>retrieval of sperm from my husband’s testis.
>Ultra sound in 2002 October showed increase of fibroid size to 41 mm
>from 20 mm median size. Myomectomy carried out on doctor’s advice to
>avoid problems in implantation after ICSI as the endometrial cavity was
>very tortous. Total number of 8 fibroids removed with two of the size
>of 51 mm. Postoperative ultra sound showed presence of fibroid
>seedlings
>Major concern now is Histopathology of fibroids
>Microscopic Description
>Sections shows proliferation of smooth muscle cells. These cells are
>pleomorphic with high N/C ratio and prommimant macronucleoli. One
>mitotic figure seen per 10 hpf
>Diagnosis
>Multiple uterine fibroids-Atypical leiomyoma
>
>My question is if we opt for fertility treatment using gonadotropins,
>are we likely to increase the chance of aggravating atypical form into
>frank cancerous form. Should I go for the fertility treatment or go for
>Hysterectomy. Can we avoid hysterectomy at present?
>

This is a very difficult situation. I don't think anybody knows what impact gonadotropins would have on atypical fibroids, but there is certainly a theoretical risk. Leaving that aside for a moment, we would not recommend that a patient desiring fertility have a hyst until after her childbearing was over. The real concern is the impact of the gonadotropins. The opinion of a gyn oncologist might be of assistance here. Do you have access to one?

-- William D. McIntosh, MD, FACOG

This is for educational purposes only, and is not a substitute for consultation and examination by a licensed medical professional.

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