ABSTRACT
Leiomyomas of the uterus are benign tumours of the smooth muscle and connective tissue in the uterus1 which can cause infertility and led to hysterectomy. This research work is a retrospective research study aimed at determining the pattern of ultrasound detectable uterine leiomyoma at Federal Medical Centre, Asaba from May 2010 to April 2012. The patients that met the inclusion criteria were those that were diagnosed to have uterine leiomyoma.
Results show that the type of uterine leiomyoma occurring least is the pedunculated 15(4.85%) and the most occurring is intra mural being 120(38.84%). The type of tumour of 47(15.21%) of the patients were not recorded in the data collected. The predominant sizes were found to be between 41-80mm accounting for 130(42.07%). The earliest onset of uterine fibroid is 20 and age group 30-34 have the highest occurrence with the frequency of 73(23.63%) and age ≥55 years with the least occurrence with an occurrence of 3(0.97%). There was also a very weak negative correlation between the sizes of the tumour and age of the patients which was statistically insignificant as p>0.05 but significant when considered groups.
Consequently, this led to the conclusion that uterine leiomyoma accounts for high rate of infertility in women and is commonly seen among the mid–premenopausal years. This if discovered on time and managed well will increase the chances of infertile women becoming fertile.
TABLE OF CONTENT
Title Page…………………………………………………………….…………..i
Approval Page…………………………………………………….…..…….…..ii
Certification…………………………………………………………………….iii
Dedication………………………………………………………..…….……….iv
Acknowledgement……………………………………………..………………..v
Abstract…………………………………………………………………….…..vi
Table of Content……………………………………………………………….vii
Lists of Tables……………………………………………………………...….xii
Lists of Figures…………………………………………………………..…....xiii
CHAPTER ONE – Introduction
1.1 Background of the Study……………………………………………………1
1.2 Statement of Problem……………………………………………………….3
1.3 Purpose of Study………………………………………..………………….4
1.3.1 Specific Objectives………………………………..……………….4
1.3.2 Research questions……………………………..………………….4
1.3.3 Research hypothesis…………………….………………………….4
1.3.4 Alternative Research hypothesis…………………………………...4
1.4 Significance of the Study……………………………………………………4
1.5 Scope of Study………………………………….………………………….5
1.6 Operational Definition of Terms……………………………………………5
CHAPTER TWO - Literature Review
2.1 Review of Related Works…………………………..………………………7
2.1.1 The Occurrence of Uterine Leiomyoma……………………………7
2.1.2 Causes and predisposing factors to Uterine Leiomyoma……..……8
2.1.3 Risk and Complications of Uterine Leiomyoma due to their sizes and locations…….9
2.1.4 The role of ultrasound in diagnosis of uterine leiomyoma……..………………16
2.2 Theoretical Background……………………………………………………17
2.2.1 Ultrasound…………….……………………………………….….17
2.2.1.1 Medical Diagnostic Ultrasonography………..……………….…18
2.2.1.3 Types of Ultrasound Scanners………………………………….20
2.2.1.4 Physiological Effects……………………………………………23
2.2.1.5 Strengths………………,……………………………………….24
2.2.1.6 Weaknesses…………………………………………………….24
2.2.1.7 Medical uses of Ultrasound…….………………………………25
2.2.2 Anatomy of the Female Reproductive System………………………..…26
2.2.2.1 The Uterus………………………...…………………………….26
2.2.2.2 Structure of the uterus…………………………..………………30
2.2.2.3 Vessels and Nerves……………………………..……………….32
2.2.2.4 Natural Variants……………..…………………….…………….33
2.2.3 Uterine Leiomyoma (Benign Tumour of the Uterus) ………….…..……33
2.2.3.1 Symptoms of Uterine leiomyoma………………………….……34
2.2.3.2 Types of Uterine leiomyoma……….……...……………………34
2.2.3.3 The Preferred Examination for uterine leiomyoma diagnosis………….…36
CHAPTER THREE - Research Methodology
3.1Research Method…………………………….………………………….38
3.2Area of Study……………………………………………………….….38
3.3Source of Data………………………………………………………….38
3.4Sample Size…………………………….……………………………….38
3.5Inclusion Criteria……………………………….……………………….39
3.6Exclusion Criteria……………………………………………………….39
3.7Method of Data Analysis…………….…….……………………………39
CHAPTER FOUR - Data Analysis and Presentation
4.1Data Analysis……………………….…………………………….…….40
4.2 Data Presentation…………………………………………………….…41
CHAPTER FIVE - Discussion and Implication of the Results, Summary of findings, Conclusion, and Recommendations
5.1 Discussion and Implication of the Results…………...………………….…45
5.2 Summary of findings………………………………………………………48
5.3 Conclusion…………………………………………………………………48
5.4 Recommendations………………….…..………………….………………48
5.5 Areas of Further Research……………..…………………..………………49
5.6 Limitations…………………………………………………………………49
REFERENCES
APPENDIX – Data of patients diagnosed with uterine leiomyoma at Federal Medical Centre, Asaba from May 2010 to April 2012.
LIST OF TABLES
Table 1: Distribution of the types of the uterine leiomyoma...…………….…..41
Table 2: Distribution of the sizes of the uterine leiomyoma...……………..…..41
Table 3: Distribution of the age of patients……………42
Table 4: Descriptive Statistics of the variables presented in Mean and Standard Deviation……42
Table 5: Pearson Moment Correlation of the Ages of patients and Size of tumours………………….……43
Table 6: Relationship between age of patients in one and type and Size of uterine leiomyoma in the other……..44
LIST OF FIGURES
Fig 1:Sagittal view of the gross anatomy of the female reproductive system……………………30
Fig 2:Locations of Fibroid in the uterus……………….……….35
INTRODUCTION
Leiomyoma is a name gotten from ‘leios’ meaning "smooth", ‘myo-‘ meaning "muscle" and ‘-oma’ meaning "tumour”. Leiomyomas of the uterus (or uterine fibroids) are benign tumours that arise from the overgrowth of smooth muscle and connective tissue in the uterus1. It is the most frequently diagnosed gynaecologic tumour, occurring in 20–30% of women older than 30 years2,3. It is also more prevalent in the black women than in the whites.
As with every benign tumour there is a risk of it becoming malignant if left unmanaged. Histologically, a monoclonal proliferation of smooth muscle cells occurs. Leiomyomas can undergo various types of degeneration as they enlarge. These include hyaline degeneration, myxoid degeneration, cystic degeneration, dystrophic calcification, and red degeneration3. Among them, hyalinization is the most common type of degeneration, occurring in up to 60% of cases4. Rarely, uterine leiomyoma may undergo malignant degeneration to become a sarcoma and the incidence of malignant degeneration is less than 1.0% and has been estimated to be as low as 0.2%3,5.
The clinical effects of these tumours are related to their local mass effect, resulting in pressure upon adjacent organs, excessive uterine bleeding, or problems related to pregnancy, including infertility and repetitive pregnancy loss6. As a consequence of these local pressure effects and bleeding, uterine leiomyoma rank as the major reason for hysterectomy in the United States, accounting for approximately one-third of all hysterectomies7, or about 200,000 hysterectomies per year8. Although the cause or causes of fibroids are unknown, the scientific literature now contains a sizeable body of information pertaining to the epidemiology, genetics, hormonal aspects, and molecular biology of these tumours.
Uterine leiomyomas usually occur in majority of women by the time they reach menopause and becomes clinically significant in about one third of the women. Despite their prevalence, little attention has been directed toward the causation and pathogenesis of fibroids until recent years because of the rarity of their malignant transformation. Regardless of their generally benign neoplastic character, uterine leiomyoma are responsible for significant morbidity in a large segment of the female population.
There are risk factors, or predisposing factors to uterine leiomyoma. In isolation, there is in fact often an overlap or interaction between one or more, for example, obesity, diet, and exercise9. Uterine leiomyoma causes a change in the normal anatomy of a female. It puts the life of the patient in danger. Also, in those within the child bearing age range may lead to infertility which is a major concern of many married couples today10. Though in relieving the symptoms before treatment proper, oral contraceptive pills can be used to decrease excessive menstrual bleeding and pain associated with uterine leiomyoma3.
Ultrasound is the imaging modality of choice in the detection and evaluation of uterine leiomyoma11,12,13,14. However, over time it has been observed that ultrasound alone may not be used for the confirmation of uterine leiomyoma2. Large, degenerated or atypical tumours may be a diagnostic challenge15. Computed tomography may help further characterize large pelvic and abdominal masses and determine their organ of origin16. In equivocal cases, magnetic resonance imaging is used as a problem solving tool to characterize uterine and adnexal pathology17,18. This implies that ultrasound has some limitations and need contributions from other imaging modalities to be able to give conclusive diagnosis.