Subserous fibroid- a benign hormone-sensitive neoplasm, which consists of smooth muscle cells of the myometrium and is located under the serosa of the uterus. In 60-70% of cases the disease is not clinically manifested. Some patients are bothered by pain in the lower abdomen and lower back, impaired reproductive function, and signs of pressure on the pelvic organs. To confirm the diagnosis, ultrasound, angiography and Dopplerography of the uterus, tomography are prescribed pelvic organs, laparoscopy. Treatment involves the use hormonal drugs, myomectomy and radical interventions.
General information
Subserous, or subperitoneal, fibroids (leiomyomas) are most often detected in women over 30 years of age. However, the current prevalence of the disease in age group 20-30 years increased by 30-35%. Women during menopause get sick extremely rarely, usually cessation menstrual function accompanied by tumor involution. In girls before menarche, subserous myomatous nodes are not detected. These statistics confirm the leading role of the hormonal factor in the development of subperitoneal leiomyoma. The incidence among city women is significantly higher than among women living in rural areas.
Causes of subserous fibroids
According to many experts in the field of gynecology, the main factors provoking the development of leiomyoma with subperitoneal nodes are endocrine disorders and pathological changes at the level of myometrial cells. The immediate causes of hormonal imbalance are:
- Central regulation disorders. Injuries and damage to the blood vessels of the brain, tumors, and constant stress affect the secretory activity of the hypothalamic-pituitary region. One of the manifestations of such disorders is the hyperproduction of FSH and LH - gonadotropic hormones that regulate the endocrine function of the ovaries.
- Extragenital endocrine pathology. Hypothyroidism, autoimmune thyroiditis, diabetes mellitus, adrenal diseases and some other diseases are accompanied by impaired estrogen production and changes in the ratio of their individual fractions.
- Ovarian diseases. With neoplasms, inflammatory processes, traumatic injuries of the uterine appendages, the secretion of estrogen and progesterone, the main female hormones, affecting the proliferative activity of myometrial cells.
- Obesity. Adipocytes have endocrine secretory activity and are capable of secreting estrogen.
- Long-term hormonal contraception. Long-term suppression of ovulation using synthetic sex hormones can disrupt their natural production.
- Congestion in the pelvic organs. Low physical activity, irregular sex life without sexual release lead to venous stagnation in the uterus and appendages with the subsequent development of hormonal imbalance.
Because the hormonal disorders are not detected in all patients with subserous myoma; some authors believe that pathological sensitivity or activity of cells in the muscular layer of the uterus plays a significant role in the development of the disease. Such violations lead to:
- Hereditary factor. Scientists have identified two groups of genes that can influence the development of myomatous nodes. Some of them provoke increased proliferation of myometrial cells, others change sensitivity to estrogen and progesterone.
- Myometrial injuries. Frequent abortions, invasive diagnostic and healing procedures, surgical interventions on the uterus cause local changes in smooth muscle cells.
Pathogenesis
At the first stage of the formation of the subserous node, pathological changes occur at the cellular level. In some smooth muscle cells, under the influence of sex hormones, metabolic processes are accelerated, and an increase in tissue permeability is noted. The second stage of pathogenesis is characterized by the appearance of cellular accumulations, defined as microscopic nodes. At the third stage, neoplasms are determined macroscopically. Nodes can form on a wide base or a thin stalk along which the vessels feeding them pass. An important point The pathogenesis of subperitoneal fibroids is a gradual decrease in the sensitivity of proliferating cells to the stimulating influence of hormones and further development tumors under the influence of their own autocrinoparacrine factors. As the disease increases, it manifests clinically as a decrease in contractility myometrium and pressure on adjacent organs.
Classification
Subserous leiomyomas may have different sizes, number of nodes, histological structure and features of location in relation to the uterus. Accordingly, the disease is classified according to the following criteria:
- By size. There are small fibroids ranging in size up to 4-5 weeks of pregnancy (up to 20 mm), medium ones - from 4-5 to 10-11 weeks (20-60 mm) and large ones - from 12 weeks (more than 60 mm).
- By number of nodes. Subperitoneal fibroids can be single or multiple.
- According to morphological structure. Based on the type and proliferative activity of smooth muscle cells, tumors are classified as simple, proliferating, and presarcoma.
- According to location features. Subserous neoplasms can grow on the surface of the uterus facing the abdominal cavity, or between its ligaments; have a wide base or stem.
Symptoms of subserous fibroids
Clinical symptoms are detected only in 30-40% of patients and indicate a significant age of the disease. Single and small neoplasias usually develop asymptomatically and are first detected during gynecological ultrasound. Subperitoneal growth of nodes is not characterized by menstrual irregularities. If the tumor has a wide base, the contractile activity of the myometrium may be impaired, which is clinically manifested by heavy and prolonged periods, the development of anemia with pale skin, complaints of general weakness, fatigue, low performance, periodic dizziness and headaches.
With large tumors, pain and signs of pressure on adjacent organs are observed. Patients complain of periodic lower back pain, which may intensify during menstruation. Particularly severe pain occurs when the myomatous node fuses with the peritoneum. When neoplasia puts pressure on the bladder, the urge to urinate becomes more frequent. Compression of the rectum is manifested by constipation, increased urge to defecate, increased hemorrhoids. Much less often, fibroids disrupt the venous outflow from the extremities, which is accompanied by edema. Unlike submucosal tumors, subperitoneal neoplasms have less impact on reproductive function– the inability to get pregnant or bear a child is usually noted only by those women whose growth of the node has led to the formation of a bend in the uterus or significant deformation of its cavity.
Complications
Most dangerous complications subserous fibroids are torsion of the legs, necrosis or infarction, which are accompanied by intense pain in the lower back and lower abdomen, severe weakness, sweating, vomiting, fever, dysfunction of the rectum and bladder. With a subperitoneal location of the tumor, secondary anemia due to blood loss, infertility and premature termination of pregnancy, myxomatous transformation of the tumor, and hyperplastic processes in the endometrium can also be observed. Malignancy occurs extremely rarely (no more than 0.25-0.75% of cases).
Diagnostics
When diagnosing subserous fibroids, a special role is played by special research methods that make it possible to detect neoplasms, determine their size, and clarify the characteristics of blood supply, location, and structure. In diagnostic terms, the most informative are:
- Gynecological examination. During a bimanual examination, an enlarged uterus and nodes on its surface are palpated.
- Transvaginal and transabdominal ultrasound. Fibroids associated with the uterus and growing towards the abdominal cavity are identified, their size, structure and location are determined.
- Dopplerography and angiography of the uterus. Allows you to assess the intensity of blood flow and visualize circulatory system uterus and detect signs indicating a malignant process.
- MRI and CT of the pelvic organs. They provide the most accurate topographic picture of the pelvic organs and myomatous nodes.
- Diagnostic laparoscopy. Subperitoneal leiomyomas are defined as round, pale pink formations with a shiny, smooth surface.
Laboratory tests may be indicative general analysis blood (erythropenia and low level hemoglobin) and study of the level of sex hormones (FSH, LH, estradiol, progesterone). Differential diagnosis carried out with pregnancy, uterine sarcoma, ovarian tumors and retroperitoneal neoplasms. If necessary, the patient is consulted by a gynecological oncologist, endocrinologist, urologist, surgeon, or therapist.
Treatment of subserous fibroids
For patients with small subperitoneal nodes with preserved reproductive function, no complaints or signs of neoplasia growth, dynamic observation with examination by a gynecologist is recommended once a year. For other forms of the disease, the specialist offers appropriate conservative, combined or surgical treatment. Women with slow-growing tumors up to 12 weeks in size and moderately severe clinical symptoms are advised to receive hormonal and symptomatic therapy. The treatment regimen may include:
- Inhibitors of gonadotropin hormone secretion. The administration of antigonadotropins and GnRH agonists (gonadotropic releasing hormones) helps to stabilize and reduce the size of the nodes.
- Progestin and estrogen-gestagen drugs. Allows you to correct hormonal imbalance and stop tumor growth in women of reproductive age, stabilize the effect of GnRH and antigonadotropins.
- Androgens. For the purpose of medicinal cessation of menstrual function, it is recommended for patients over 45 years of age who are not planning a pregnancy.
- Symptomatic remedies. In the presence of pain, analgesics are prescribed; in case of metrorrhagia, hemostatic agents and drugs for uterine contraction are prescribed. According to indications, iron supplements, vitamins, mineral complexes, etc. are used.
One of the best solutions for patients of childbearing age with a single or several slow-growing neoplasia measuring 50 mm or more, if present clinical manifestations is combination therapy. The method involves conservative myomectomy, before which GnRH agonists are prescribed to stabilize the growth of myomatous nodes. A course of treatment with drugs that inhibit the secretion of gonadotropic hormones is also recommended in the postoperative period to prevent relapse.
For rapidly growing subperitoneal myomas larger than 60 mm, pronounced pain syndrome, metrorrhagia, disorders of reproductive function and pelvic organs are indicated surgical methods. Unlike submucosal fibroids, when treating subserous neoplasms, it is not recommended to use uterine artery embolization due to high risk necrosis. Taking into account the reproductive plans of women and the characteristics of the course of the disease, various organ-preserving and radical interventions are performed:
- Laparoscopic and laparotomy myomectomy. For cutting and enucleation of subperitoneal nodes, mechanical, electrical and laser surgical instruments are used.
- FUS ablation. Despite its low invasiveness, the method is used to a limited extent. It cannot be prescribed in the presence of 6 or more nodes, large neoplasia and pedunculated tumors.
- Semi-radical and radical operations. During transvaginal, laparoscopic or laparotomic surgery, defundation, high and regular supravaginal amputation or total hysterectomy are performed.
Prognosis and prevention
Subserous fibroids are benign neoplasm with a low risk of malignancy and a favorable prognosis. Timely detection of the disease and correct tactics treatments allow you to restore menstrual and reproductive function. To reduce the risk of developing subperitoneal nodes and complications in the presence of a tumor, it is recommended to regularly see a gynecologist (especially in diseases accompanied by hyperestrogenemia), rationally use contraceptive methods, and undergo invasive procedures strictly according to indications.
There are several types of myomatous nodes. A subserous myomatous node is located on the outside of the uterus and may have a base - a pedicle. Its structure determines the methods of treatment for this condition.
Uterine fibroids occur due to a violation of the regulation of cell growth in the muscle tissue of the organ. The impetus is most often hormonal disorders and previous operations on the uterus.
Myoma can be single and differ in location. According to the medical classification, the following types of tumor are distinguished:
- Submucosal myomatous neoplasm– located in the submucosa of the organ on a thin stalk.
- Interstitial, or intramural– located between the muscular layers of the uterus.
- Subserous tumor– localization outside the uterus, may have a stalk.
- Intraligamentary node– located on or between ligaments.
- Less common born And nodes in the cervix.
For development pathological process In the uterus, not only reproductive hormones affect, but also dysfunction of the thyroid gland. For example, hypothyroidism is combined with an increase in estrogen levels. This can serve as an impetus for the development of a benign hormone-dependent tumor.
After cavity curettage and installation of a spiral, the uterine mucosa is often damaged and its structure is disrupted. Unfavorable factors are also the combination of the influence on the body of bad heredity, unfavorable environment, negative emotions and poor resistance to pathogenic microorganisms.
They range from 1.5 cm to a dozen cm. However, they are more often discovered when they reach at least 4-5 weeks.
Diagnosis of subserous fibroids
Despite the fact that subserous uterine fibroids are a benign formation, they are capable of... The rate of malignancy depends on the type of fibroid and the combination of external factors.
When diagnosed, this type of fibroid looks like a node on a broad base or pedicle, through which its nutrition and growth occur. A single node is covered by a capsule, limited from surrounding tissues, and is easily visualized. Multiple formations are difficult to separate from each other. The diameter of each of them does not exceed 10 cm.
Localization outside the uterus limits tumor involvement and does not contribute to organ enlargement. As a result, there are no obstacles to conceiving a child. If the subserous node is located near the fallopian tube, it can lead to disruption of its patency as a result of compression. In this case, maintaining the pregnancy is difficult.
Types of subserous uterine fibroids
In gynecology, a convenient classification of subserous nodes is provided.
According to it, all fibroids of this type are divided into the following types:
- a null subserous node on a pedicle, differs in that it is not intramural.
- In the first type, the percentage of content of the intramural component occupies half of the node.
- The second type is spoken of when the intramural contents make up more than half of the node and the subserous component is less pronounced compared to the first type.
Myomatous node on the anterior wall occurs in most women, location back wall typical for . The subserous node grows into the peritoneal cavity and unfolds in rare cases.
Reasons for development
As noted, the development of a tumor can be influenced by the following factors:
- disturbances in the functioning of the endocrine system;
- hereditary predisposition;
- damage to the uterine myometrium.
Pathologies of a subserous nature are focused on painful sensations of a pulling, aching nature. The area of their localization is the upper abdomen, with irradiation to the back.
The pain may intensify after physical fatigue, stiffness of the pelvic muscles, or against the background of colds.
How is subserous fibroid diagnosed?
A standard appointment with a gynecologist includes a mandatory medical history and history study chronic pathologies. In-depth medical examination includes a blood test (detailed clinical, biochemistry, hormones); inspection using mirrors; ultrasound examination; magnetic resonance imaging.
Treatment methods
Treatment can also be radical. If a neoplasm is detected on early stage development, observation tactics are allowed. Speech in this case goes about fibroids before 12 weeks of pregnancy. If a woman’s hormonal background does not require correction,
Only chronic foci of infection are sanitized.
Drug therapy
At a size of 12-15 weeks, treatment with oral and hormonal contraceptives, to reduce the production of hormones by the ovaries. Medicines are taken for at least six months. Another treatment option is. This method of treatment also combines a contraceptive function. The peculiarity of the latest method of therapy is that the IUD is placed only on women who have given birth. There are contraindications to the use of hormonal drugs:
- increased amount of glucose in the blood;
- phlebeurysm;
- hypertension.
Additionally, symptomatic medications are prescribed: painkillers, iron, vitamin complexes, hemostatic drugs. Physiotherapy includes magnetic therapy and radon baths.
Treatment during pregnancy
A subserous myomatous node can be detected during pregnancy on ultrasound. What complications does this pathology threaten? If the tumor is located on a pedicle, it may become torsion. The operation is carried out taking into account all the risks to the fetus. When the pregnancy cannot be terminated, expectant management remains. The growth of fibroids can lead to compression of the ureters, which will lead to impaired kidney function, development dangerous condition– pyelonephritis. Due to irradiation into the rectal area, inflammation occurs. However, monitoring the entire period of pregnancy makes it possible to prevent complications for mother and baby in time. When determining treatment tactics, the doctor takes into account several factors:
- gestational age;
- tumor size and type;
- location of education;
- patient's age.
A large tumor is removed surgically, laparoscopy or abdominal method. The choice of tactics is determined by the doctor according to the indications.
Surgery
The absolute indications for removal of the uterus are its development on a pedicle and big sizes. Also, the surgical method is resorted to in cases of severe pain, infertility and the ineffectiveness of conservative drug therapy.
Abdominal surgery is used as a radical method of getting rid of a tumor. Indications for its implementation:
- large node size;
- tumor degeneration.
The fibroid is excised in the suprapubic region after dissecting all layers of tissue.
A hysterectomy involves removing the tumor along with the organ. It is carried out according to vital signs and only to women who have given birth.
Laparoscopy is a modern gentle method. Its advantage is the absence of postoperative scars and rapid recovery after surgery.
Embolization of the uterine arteries is not used very often. The method consists of stopping the supply of the node after blocking the blood flow to it. This method is an alternative to surgery.
Planning pregnancy after surgery
Doctors always try to preserve the uterus during surgery to remove fibroids. The duration of recovery depends on the method of chosen therapy, individual physiological characteristics women. In any case, if you follow the recommendations of your attending physician, you can plan to conceive within a year after the operation with normal tissue healing.
Nutrition for subserous node
A properly formulated diet also has great importance to restore the woman’s body. To normalize the functioning of the digestive tract, the level of hormones and vitamins, you must adhere to the following scheme:
- To normalize metabolism, food must be plant-based and contain sufficient fiber.
- Buy lean meat: poultry, veal.
- Avoid spicy, spicy, fried foods.
- Consume dairy products, grain products daily to remove toxins from the body.
- Sea fish has an antitumor effect and contains a complex of minerals.
Poor nutrition during the rehabilitation period will slow down the recovery process and cause general harm to the body.
After thirty, a woman should undergo a full gynecological examination every six months, this significantly reduces the risk of developing pathologies of the reproductive system. Regularly taking care of your health will minimize negative factors.
Interesting video:
Every woman dreams of carrying and giving birth healthy child. Becoming a mother is a real happiness and a great responsibility. After all, a woman not only gives life to a new person, she is completely responsible for his life and development. And this responsibility arises even at the stage of pregnancy planning. This is why it is so important to undergo full examination for the presence of various pathologies of the female organs.
The uterus is the main reproductive organ of a woman, responsible for embryo implantation and gestation.
One of the problems that women of childbearing age often face is subserous uterine fibroids. This is a benign tumor in the form of a node under the outer lining of the uterus, in the abdominal region (subperitoneal node) or in the pelvis. Often consists of several nodes with different localizations.
The node has a round shape, consists of smooth muscle fibers and has a high density. It does not change the structure of the walls of the uterus and does not interfere with pregnancy. It is attached to the uterus by its base or stalk.
Symptoms, factors of formation and complications of the subserous node
The nature of the symptoms directly depends on the size of the tumor and the stage of the disease. Many signs are inherent in different infectious diseases, as well as bowel and bladder disorders, which often misleads patients. Let's consider the following stages presented in the table.
This pathology develops against the background of such factors and diseases:
If treated incorrectly or not diagnosed in a timely manner, the disease is dangerous due to the onset of complications in the form of slagging of the body (improper functioning of the intestines), pyelonephritis, kidney stones and bladder, uterine bleeding and infertility.
Large tumor sizes lead to its rupture or twisting of the fibroid stalk. Such phenomena cause peritonitis and tumor necrosis, which requires immediate medical intervention surgeon
During pregnancy, there is a threat of miscarriage and premature birth, fetal hypoxia ( oxygen starvation), caused by the flow of a significant volume of blood not to the child, but to the tumor itself. The most unfavorable complication is the degeneration of the tumor from benign to malignant – sarcoma.
Diagnostic detection methods
This formation has no age barrier and can appear both at 30-40 years old and before 20 years old. Since this disease is often asymptomatic, it can only be detected during gynecological examination using palpation.
There are special technical procedures used by a doctor to identify fibroids:
Conservative treatment of subserous fibroids
In the initial stages, when there is no room for deformation changes in the uterus, the tumor responds well to drug treatment, which is aimed at increasing immunity, restoring hormonal balance, and eliminating inflammatory process uterus. All this allows you to preserve the organ and prevent the growth of fibroids.
Conditions for drug treatment:
- initial stage of the disease;
- small size of the subserous node (less than 6 cm);
- slow growth rate of the tumor;
- surgical intervention is contraindicated.
The main drugs used for such treatment are hormonal drugs, as well as diet and supportive care.
| Group | Name of drugs | Mechanism of action | Contraindications | A course of treatment |
|---|---|---|---|---|
| Progestogens (steroid sex hormones) | Norkolut, Duphaston, Utrozhestan, Progestogel, Norprogesterone | Prevention of oncology, preventing the growth of the endometrium | Vaginal and uterine bleeding, pregnancy, thrombophlebitis, breast cancer | 8 months |
| Combined oral contraceptives | Yarina, Janine, Regulon, Marvelon, Novinet, Lindinet, Ovidon | Stabilization of the size of myomatous nodes, normalization of menstruation, reduction of blood loss | Deep vein thrombosis, arterial hypertension, stroke, ischemic disease hearts | 3 months |
| Gonadotropin releasing hormone agonists | Buserelin, Zoladex, Triptorelin, Goserelin | Reducing the size of the subserous node, relieving pelvic pain | Pregnancy and lactation | From 2 to 6 months |
| Antigonadotropins | Gestrinone, Danazol | Suppression of the synthesis of ovarian steroid hormones | Heart disease, kidney disease, pregnancy, diabetes | 8 months |
| Hormonal IUDs | Mirena, Levonova | Blocking tumor growth | Cervicitis, postpartum endometritis, septic abortion, genitourinary tract infections | 5 years |
Along with these drugs, painkillers and anti-inflammatory drugs are used: Paracetamol, Ibuprofen, Ketoprofen, Naproxen and others.
Is it worth operating on subserous uterine fibroids?
If the medications do not give the desired result, and the next ultrasound shows the growth of the tumor, its twisting or degeneration into a malignant one, an operation is immediately prescribed, which can be of 2 types:
- With preservation of the uterus– myomectomy and hysteroresectoscopy.
- Without organ preservation– hysterectomy.
Myomectomy is aimed at removing fibroids using laparoscopy, hysteroscopy, laparotomy (an incision in the abdominal wall) and allows the woman to become pregnant in the future. Used in patients of reproductive age.
Hysteroresectoscopy involves removing fibroids from the inner surface of the uterus without making incisions in the abdominal cavity.
Hysterectomy – complete removal uterus with a malignant tumor. Allows you to maintain sexual activity, but forever excludes the possibility of motherhood. It can be laparoscopic, laparotomic and vaginal.
Subtypes of hysterectomy:
- total – removal of the uterus and cervix;
- subtotal – preservation of the cervix;
- radical - amputation of not only the uterus and its cervix, but also part of the vagina, as well as appendages.
The feasibility of the operation is determined by an obstetrician-gynecologist or oncologist, taking into account the patient’s age, the nature of the tumor, and the presence of blood loss.
This disease is not a death sentence for a woman if you follow certain rules and doctor’s recommendations:
Early diagnosis and timely initiation of therapy will help a woman maintain her reproductive function until she is 40 years old.
Among benign formations it is quite common.
It has many varieties - some tumors develop inside the uterus, others are located on the outer layer of the uterine body, others are formed in muscle layer organ. One of these types is subserous myomatous tumor.
What is subserous uterine fibroid?
Typically, such formations have a fairly wide base, connected to the uterine tissues through a thin stalk. This leg is a kind of channel through which nutrition for the tumor passes. The nodule can be single in nature, although multiple small formations are also found.
Such myomatous tumors are found more often in women of reproductive age. They grow slowly and develop latently. Subserous myomatous tumor is dangerous due to torsion of the pedicle, which results in necrosis of tumor tissue.
Causes
The main factor contributing to the development of benign subserous tumors in women is changes in the hormonal status of women.
According to doctors, the tumor is not capable of forming in healthy body, therefore, for its development specific prerequisites are needed such as:
- Surgical manipulations in the female genitourinary organs. This category includes various diagnostic curettage, abortions, laparoscopic examinations, etc. These interventions injure the uterine muscle tissue, which provokes the formation of a tumor;
- Genetically determined predisposition to this pathology;
- Presence of a history of operations on;
- Various types of inflammation or infection in the genitourinary area;
- Long-term contraception with hormonal contraceptives;
- Tumors in the appendages or mammary tissues;
- Functional problems in the thyroid and adrenal structures.
Typically, the causes of the disease are a group of factors that, to varying degrees, influence the formation of the myomatous process in the uterine body.
Clinical picture
Externally, a subserous tumor looks like a node. This type of myomatous formations is considered the safest, since it differs in its external uterine localization and grows towards the retroperitoneal space. Such a tumor does not provoke an increase in the uterine body and is not capable of affecting menstrual cycle.
Such a formation does not harm pregnancy, which occurs without difficulties with such a disease; a subserous formation cannot harm delivery, however, it is quite capable of causing a spontaneous miscarriage.
Sometimes reproductive difficulties occur if the formation is located in close proximity to the tubes and compresses them.
As education grows in abdominal space, then it develops mainly without symptoms, at least during the period while the node is of insignificant size. When the formation grows, it begins to compress the surrounding tissues and organic systems, which leads to their functional disorders.
In general, subserous myomatous formation can be characterized by the following symptoms:
- Frequent constipation;
- Hemorrhoidal inflammation;
- Difficult and frequent urination causing pain;
- Hyperthermia
- Hypersweating, dizziness;
- Discomfortable sensations in the abdomen and lower back when sitting or standing;
- Painful symptoms of an aching nature, localized in the area above the pubis, in the lower back, and lower half of the abdominal wall.
Painful symptoms tend to occur against the background of prolonged standing, long walking, or heavy physical activity. Often the pain becomes cramping in nature, which indicates the development of an exacerbation or active growth of the tumor.
Expressiveness pain symptom atiki usually determined by the parameters, location and development of the myomatous node. If the tumor grows with abdominal wall, then the patient will constantly suffer from pain.
Varieties
Subserous myomatous nodes can be multiple or single.
Single ones are distinguished by the presence of a shell like a capsule.
Multiple formations are found somewhat less frequently, but they are accompanied by more severe painful symptoms.
If multiple myomatosis becomes large in size, then adjacent structures are compressed, which disrupts their activity. In addition, they are divided into interstitial or intramural uterine fibroids.
Intramural
Intramural subserous fibroids are localized on the outer uterine layer. This formation is considered the “safest”, since it does not affect the size of the uterine body and the menstrual cycle, and does not interfere with reproductive abilities.
Such a tumor is formed from smooth muscle fibers, as well as connective tissue structures. It is believed that such fibroids occur in a kind of lighter version.
Interstitial subserosal
The subserous-interstitial myomatous node is formed in the thickness of the wall of the uterine body, but grows towards the small pelvic cavity. Such a formation belongs to the category of mixed tumors and is somewhat different from a traditional subserous tumor.
It develops in the muscle layer, and therefore leads to a slight increase in the body of the uterus. An interstitial subserous myomatous node can negatively affect surrounding tissues, but its size rarely exceeds 10 cm.
Stages
Experts stage the development of such myomatous formations into several stages:
- First stage – active growth is observed, the tumor is distinguished by the full course of metabolic processes and increased vascular permeability;
- Second the stage is characterized by rapid progression, but it is still impossible to detect a formation without microscopic examination;
- On the third stage, myomatous formation is easily detected during a medical examination.
Typically, such tumors are of a multiple nature, when several formations develop simultaneously.
How dangerous is this disease?
The danger of subserous fibroids lies in the high probability of torsion of the pedicle, through which the formation receives the necessary nutrition. This complication is usually caused by atrophic changes fabrics.
As a result of such changes, necrosis of tumor tissue occurs, provoking purulent-inflammatory processes in nearby structures.
Tissue death is usually accompanied by hyperthermic symptoms, intense pain, severe tachycardic symptoms, increased sweating, dizziness and other intoxication symptoms.
Diagnosis and treatment
When diagnosing subserous myomatous formations, the following diagnostic measures are most often used:
- Echography;
- Magnetic resonance imaging, which allows you to obtain a layer-by-layer image of the tumor;
- Diagnostic curettage in in this case carried out to determine changes in the mucous uterine tissues;
- Hydrosonographic diagnostics - allows you to detect even the smallest tumors and determine the degree of their development;
- Laparoscopic examination is used if it is impossible to differentiate the pathology.
Most often, treatment of the subserous form of uterine fibroids is surgical, especially in the presence of large formations, heavy blood loss, torsion of the legs, rapid growth and tumor progression.
In the photo, removed subserous uterine fibroids
To implement surgical procedures Several common techniques are used, such as laparoscopic myomectomy, which involves removing the tumor through several punctures through enucleation.
In addition, hysteroscopic myomectomy is used, when the node is removed through the vagina. IN difficult cases the formation is removed along with the appendages and uterus, i.e. a total hysterectomy is performed.
IN last years wide application received, which involves removing the tumor using ultrasound.
Treatment with folk remedies
Among the traditional methods of treating subserous uterine fibroids, healing ointments, extracts, medicinal tinctures or vaginal suppositories. Usually, for the preparation of such medicines, raw materials are used in the form of poisonous plants that have antitumor activity.
Therefore, such medications should be taken with extreme caution. Experts do not rule out the presence therapeutic effect from similar healing agents traditional medicine However, they are recommended to be used as additional therapy and in the absence of contraindications.
Prognosis and prevention
Subserous forms of myomatous formations are characterized by a high rate of benignity, and therefore do not have a tendency to malignancy. The prognosis is generally positive, however, if there is rapid growth and progression of the pathology, surgical intervention may be necessary.
Even benign tumors can significantly ruin a woman’s life and deprive her of opportunities for motherhood. Therefore, it is necessary to contact a specialist when the first suspicion of pathology appears.
An annual gynecological examination will serve as an excellent prevention of the neglect of such tumors, since it allows them to be differentiated in a timely manner.
In addition, to prevent myomatous formations, it is necessary to avoid abortions, give birth and breastfeed a child until the age of 30, and promptly treat gynecological problems, control hormonal status, avoid long-term hormonal contraception.
This is the only way to protect yourself from the occurrence of serous uterine myomatous formations, and, therefore, to avoid possible complications such as infertility, purulent-inflammatory processes in the uterus and total hysterectomy, which deprives the patient of a chance for successful motherhood.
The video shows laparoscopic surgery for subserous uterine fibroids:
Uterine fibroids are a benign formation of smooth muscle, chaotically intertwined fibers, accounting for up to 25% of all diseases of the female genital area. The most common type is interstitial fibroid of the muscular layer of the uterus. About 35% of all diagnosed formations are subserous, submucosal is less common, and very rarely - fibroids in the interligamentous space, the cervical area. Smooth muscle formations can develop in single or multiple nodes; multiple nodules are more often diagnosed.
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The disease is getting younger every year - it is found in young women, and there are cases of fibroids being detected in girls. Most often, myomatous nodes are diagnosed in women over 35 years of age, as well as in menopause. The menopausal period is characterized by hormonal changes, during which the balance of hormones is disrupted, which becomes one of the reasons for the growth of smooth muscle nodes of the uterine wall.
Factors that influence the development of the disease include frequent abortions, injuries to the walls of the uterus, surgeries on the reproductive organ, diseases of the genital organs, endocrine system and other factors. The real reason for the development of smooth muscle nodes has not yet been studied. Often the disease has a hereditary predisposition when it occurs in several women of the same family.
To inform women about methods of diagnosing and treating fibroids, an expert council of doctors was created who devoted themselves to studying and developing methods for treating the disease while preserving the reproductive organ. Women with fibroids can turn to expert advice and get advice; doctors will answer all questions during.
Nodes in the body of the uterus
A healthy female reproductive organ is about 9-11 cm in length in women who have given birth, the uterus is 4 to 5 cm wide. The reproductive organ has three layers - peritoneal (serous), muscular (myometrium), mucous (endometrium). The nodes in the body of the uterus consist of muscle and connective tissue. The nodes of the muscular layer of the uterus are named depending on their location:
- Developing in the myometrium are the interstitial nodes of the uterus.
- Formations growing towards the endometrium are submucosal (submucosal) nodes.
- Smooth muscle formations growing towards the abdominal cavity are called subserous fibroids.
- Between the leaves of the broad ligament of the uterus there are intraligamentary nodes.
The most common formations are the muscular wall (body) of the uterus, less often the cervix.
What is fibroid: subserous node
Subserous fibroid is a benign formation that has formed in the muscle layer and grows towards the abdominal cavity. It can be located on a wide base or a thin leg. Development of smooth muscle subserous formation on initial stage occurs asymptomatically, with its growth the first signs appear - pain in the lower abdomen, often radiating to the rectum, vagina, and lower back. The most pronounced pain symptom is with a subserous node on a wide base. Single subserous formations are located in a dense capsule, which separates them from the surrounding tissues.
Subserous formation can be of several types:
- Fibroid - consists of muscle fibers and a large amount of connective tissue.
- Leiomyoma is bizarre - histological examination reveals giant cells with several large nuclei.
- Leiomyoma - formation consists of smooth muscle cells.
- Leiomyoblastoma - the boundaries of the formation are unclear, the cells of the nodes have band-forming, light eosinophilic cytoplasm.
- Leiomyolipoma – degeneration processes occur in the nodular formation and mature fat cells appear.
Reasons for development
The reasons for the development of a subserous node are not fully understood; factors that influence its appearance and growth are known. Fibroids are sensitive to hormones - modified smooth muscle fibers have more receptors sensitive to the effects of hormones than healthy myometrium. The effect of steroid hormones on nodular formations leads to their rapid growth. Hormonal disruptions, imbalance of hormones are observed during pregnancy, menopause, overweight women. Various factors contribute to the appearance and growth of nodes:
- Diagnostic curettage, abortion, difficult childbirth.
- Hereditary predisposition.
- Chronic inflammatory processes in the female genital organs.
- Ovarian diseases.
- Diseases of the endocrine system.
- Infertility.
The stage of development of the disease is determined by the size of the uterine node:
- Small – 20 (mm).
- Average – from 20 to 60 (mm).
- Large – from 60 (mm) and more.
Uterine fibroids are also described in weeks of pregnancy - the size of the uterus corresponds to a specific week of pregnancy.
Subserous node on the anterior and posterior wall of the uterus
A growing subserous node along the anterior wall of the uterus can lead to the development of problems with urination, compression of the ureter, the development of kidney diseases (pyelonephritis), and impaired renal and bladder function. Growing subserous fibroids on the back wall of the uterus compresses the intestines, blood circulation in the intestines is disrupted, and constipation occurs.
Subserous node on a pedicle in the uterus
Subserous formation is often located not on a wide base, but on a thin stalk. The pedicle can be long and thin; the subserous node on the pedicle is located in the abdominal cavity. This arrangement is very dangerous - torsion of the leg or its injury can cause tissue necrosis of the myomatous formation and the development of complications. The patient has a rise heat, severe abdominal pain and weakness appear, and as the condition worsens, the patient loses consciousness. The situation becomes dangerous for the health and life of the woman.
Diagnostics
If symptoms of fibroids appear, you should immediately undergo a diagnosis of the disease by a gynecologist. Subserous fibroids often cause pain while walking, pain and discomfort during sexual intercourse, the ability of the myometrium to contract is impaired, and menstruation becomes heavy and painful. Early diagnosis will preserve reproductive function and reduce the risk of complications. Small fibroids respond better to treatment than large fibroids.
Diagnosis of the disease begins with an examination by a gynecologist. During the examination, the doctor determines the condition of the uterus, the presence of deformation of the organ, and its size. Changes in contours, size, pain during examination become the reason for prescribing diagnostic studies. To diagnose the disease, they are referred to ultrasound, MRI or CT, various tests. Additionally, laparoscopy or hysteroscopy may be prescribed to examine the tissues of the formation.
Histological examination will determine the type of fibroid. Due to malnutrition, the subserous node has areas of necrosis, mucoid and myxomatous degeneration, hyalinosis, hemorrhages, and calcification. An ultrasound will help determine the location of the fibroid, its size, tissue structure, the condition of the organs and tissues located next to the fibroid. Magnetic resonance imaging serves to clarify the nature of the formation and helps determine the benign or malignant nature of the formation.
Subserous myomatous node of the uterus: complications
The growth of subserous formation can lead to various complications. One of the complications is torsion of the pedicle of the subserous node, causing tissue necrosis and the development of an inflammatory process. A growing subserous node can put pressure on neighboring organs and disrupt the blood circulation of tissues - this leads to the development stagnation in the bladder, intestines. A large formation can deform the uterus, cause the organ to bend, and the position of the uterus will prevent conception. The fusion of myomatous formation with the peritoneum causes severe pain during movement and physical activity. When the capsule of the subserous node ruptures, the contents enter the abdominal cavity, peritonitis develops, which can result in fatal in case of untimely provision of assistance.
Subserous node in the uterus: to operate or not
There are certain indications for surgical treatment - large fibroids, torsion of the node, peritonitis, various complications that require immediate attention. surgical intervention. Whether to operate or not to operate on fibroids can only be answered by a doctor who will be guided by the individual characteristics of the patient’s body, her state of health, and the size of the fibroids.
Subserous node of the uterus and pregnancy
This type of formation rarely affects conception and pregnancy; the course of pregnancy depends on the size and location of the node. If there is a large node, it is recommended to remove it before planning a pregnancy.
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Uterine fibroids, subserous node: treatment
When prescribing treatment, the doctor is guided by the patient’s age, the size of the formation, its location, general condition sick, presence concomitant diseases. The woman is undergoing tests for endometriosis, tumors of the uterine appendages, cancer of the mucous layer of the uterus - the endometrium. Drug therapy is not prescribed: in the presence of large nodules, prolonged and heavy bleeding, or rapid growth of the nodule. Young women with small nodules are prescribed oral contraceptives, the Mirena spiral with hormonal content is recommended, and hormonal therapy is carried out.
Treatment of fibroids is carried out using organ-preserving methods and radical surgery (removal of the reproductive organ), when the uterus is significantly deformed, the fibroid nodes are huge, and the course of the disease is complicated.
Organ-preserving techniques include uterine artery embolization (UAE). Embolization of the uterine arteries allows the treatment of all myomatous nodes during one procedure, does not require the use of general anesthesia, and the procedure is bloodless and painless. The doctor performs UAE through a puncture of the femoral artery, observing the passage of special microbeads - emboli - into the vessels of the fibroids. Together with emboli, a contrast agent is used, which helps to observe the entire process of movement of polymer particles through the vessels, blocking of the vessels of the nodular formation. Complete destruction of the nodes occurs within several months. After the procedure performed by an experienced specialist, a woman can plan a pregnancy.
Treatment of fibroids should be carried out in modern, specializing in the treatment of the disease, using a variety of treatment methods, including the most modern techniques.
Bibliography
- Lipsky A. A.,. Gynecology // encyclopedic Dictionary Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg. 1890-1907.
- Bodyazhina, V.I. Textbook of gynecology / V.I. Bodyazhina, K.N. Zhmakin. - M.: State Publishing House of Medical Literature, 2010. - 368 p.
- Braude, I. L. Operative gynecology / I. L. Braude. - M.: State Publishing House of Medical Literature, 2008. - 728 p.
