Uterine fibroids are the most common benign tumors in the female reproductive organs. About 20%-25% of women of childbearing age suffer from uterine fibroids, and the probability of uterine fibroids degeneration accounts for about 6.5% of fibroids. When the fibroid grows too fast, too large, or compresses the fibroid supply blood vessels, it will cause insufficient blood supply of the fibroid to occur and ischemia, losing its original typical structure, and degeneration occurs. Degenerative fibroids are generally larger, and are more common in the myometrium and subseroses, which is directly related to the blood supply characteristics of fibroids. Uterine fibroid degeneration is divided into benign and malignant.
benign fibroids
glass-like transformation, cystic transformation, steatosis, red degeneration, calcification, and atrophy.
glass-like change
is also called transparent denaturation, the most common. The vortex structure of the fibroid profile disappears and is replaced by a uniform and transparent substance. The myocytes in the lesion area were seen disappearing under the microscope, making it a uniform, transparent and structurally unstructured area.
cystic change
is mostly secondary to the glass-like change, and its tissues are necrotic and liquefied to form one or more capsules. The capsule contains clear and colorless liquid, and can also solidify into a gelatinous shape.
steatosis
mostly occurs in the late stage of clear degeneration or after necrosis, and may also form fat tissue due to the metaplasia of the fibroids. Local strong echoes are seen in the tumor body, and the boundary between them is clear. Occasionally, the entire fibroid body is in a strong light cluster, which is mostly a precursor of calcification.
Red degeneration
is a special type of fibroid necrosis, which is seen during pregnancy or puerperal period. After pregnancy, the rapid growth of fibroids causes a relatively reduced blood flow perfusion, which leads to ischemia and necrosis, and a "red-like transformation" occurs. The clinical manifestations are rapid growth of fibroids, and patients experience severe abdominal pain, fever and elevated white blood cell count. Microscopic examination showed that the tissue was highly edema, the thrombosis of large veins in the pseudocapsular and small veins in the body, extensive bleeding with hemolysis, decreased myocytes, nucleus often dissolved and disappeared, and there were more fat globules deposition.
Calcification and atrophy
After menopause , women, due to the decrease in hormone levels, their fibroids become smaller and hardened, and calcium salts are deposited in the tumor to form a gravel or thin shell. After that, the entire tumor will become a calcified block called uterine stone.
Malignant changes in fibroids: Sarcoma becomes
The chance of sarcoma developing into fibroids is relatively low, about 0.2%-0.5%. Clinical manifestations are that the tumor grows rapidly in a short period of time, accompanied by vaginal bleeding. The section of the tumor is gray-yellow, with a crisp and soft texture, and looks like raw fish meat. It is very easy to be ignored because there are no obvious symptoms. Under the microscope, smooth muscle cells proliferate, disordered arrangement, vortex structure disappears, and cells have atypical properties. nuclear division is easy to see.
Reference for information: Xijiao First Affiliated Hospital Obstetrics and Gynecology
