| Abstract [eng] |
Aim: Review of the literature to understand the mechanism of uterine fibroids, the clinical features of the disease, the main methods of treatment and diagnosis, and to describe a clinical case. Methods: The literature search was performed in the PubMed database. The selection criteria were: english language and publications between the years 2004 and 2023. According to the selection criteria and the relevant keywords, 42 scientific publications were identified in the PubMed database and selected for the final literature review. Data storage was performed with Zotero reference management software. Case report: In 2023, a 57-year-old female patient was referred from secondary level hospital to Vilnius University Hospital Santaros Clinics for a tumour of unknown or unclear course. Echoscopic examination revealed a clear, smooth-walled mass in the uterine cavity. Magnetic resonance imaging revealed a large mass in the uterine cavity, most similar to a uterine leiomyoma with cystic degeneration. Elective surgery was performed: laparoscopic total hysterectomy with bilateral salpingoovarectomy. The surgical specimen (uterus with appendages) was sent to the State Pathology Centre for examination, and definitive diagnosis of pathology was received: intramural uterine leiomyomas, one (largest) with bizzare nuclei (symplastic) leiomyoma, right ovarian embedded cysts, serous tubal intraepithelial lesion (STIL) of the right fallopian tube. On the second postoperative day, the patient complained of abdominal pain, diarrhoea and fever up to 390C – diagnosed acute peritonitis. Relaparoscopy, abdominal lavage and drainage were performed and a course of antibiotic therapy was prescribed. After the treatment plan was completed, the patient was discharged home and six months later she had no complaints. Conclusions: Uterine fibroids are one of the most common benign gynaecological tumours in women of reproductive age. According to various sources, the prevalence of uterine myomas in women ranges from 4.5% to 68.8%, with cystic degeneration accounting for only 4% of all uterine myoma cases. The course of the disease is usually asymptomatic, but 30% of cases present with painful, heavy menstrual periods and abnormal uterine bleeding. Ultrasound is considered the "gold standard" in the diagnosis of uterine leiomyomas, while MRI provides more accurate data on the morphology and degeneration of the tumours. Effective treatment consists of a variety of methods: conservative hormonal treatment and surgical interventions (e.g. myomectomy, hysterectomy). Myomectomy is the preferred treatment for cystic degenerated fibroids in younger patients (to preserve fertility) and hysterectomy in older patients. |
