Leiomyoma

A leiomyoma (plural is 'leiomyomata') is a benign smooth muscle neoplasm that is not premalignant. They can occur in any organ, but the most common forms occur in the uterus, small bowel and the esophagus.

Etymology

 * Greek:
 * λεῖος leios "smooth"
 * μῦς mus (cf. myo-) "mouse or muscle"
 * -ωμα -oma "tumor"
 * Latin:
 * fibra "fiber"



Uterine leiomyomata
Uterine fibroids are leiomyomata of the uterine smooth muscle. As other leiomyomata, they are benign, but may lead to excessive menstrual bleeding (menorrhagia), often cause anemia and may lead to infertility. Enucleation is removal of fibroids without removing the uterus (hysterectomy), which is also commonly performed. Laser surgery (called myolysis) is increasingly used, and provides a viable alternative to traditional surgeries.

Oral contraceptive pills can be used to decrease excessive menstrual bleeding and pain associated with uterine fibroids.

Uterine leiomyomas originate in the myometrium and are classified by location:
 * Submucosal – lie just beneath the endometrium.
 * Intramural – lie within the uterine wall.
 * Subserosal – lie at the serosal surface of the uterus or may bulge out from the myometrium and can become pedunculated.

A rare form of these tumors is lipoleiomyoma.

Esophageal
They are also the most common benign esophageal tumour, though this accounts for less than 1% of esophageal neoplasms. The remainder consists mainly of carcinomas. Although the vast majority of benign esophageal tumors are clinically silent and go undetected, large or strategically located tumors may become symptomatic.

Cutaneous
Leiomyomas of the skin are generally (1) acquired, and (2) divided into several categories :


 * Solitary cutaneous leiomyoma
 * Multiple cutaneous (or pilar) leiomyomas arising from the arrectores pilorum muscles
 * Angioleiomyomas (Vascular leiomyomas) that are thought to arise from vascular smooth muscle
 * Dartoic (or genital) leiomyomas originating in the dartos muscles of the genitalia, areola, and nipple
 * Angiolipoleiomyoma

Leiomyoma of jejunum
Leiomyoma is the most common benign tumor of small bowel. Approximately 50% of cases are found in the jejunum, followed by the ileum in 31% of cases. Almost one half of all lesions are less than 5 centimeters.

Diagnosis
Diagnosis depends on position of the myomas. Traditional Transabdominal or Transvaginal ultrasonogram can detect large submucosal and transmural myomas. For submucosal myomas saline infusion sonography is the best.

Medical treatment
GnRH agonists for 3–6 months are used to reduce the size of the myomas. It usually reduces the size by 60% to 70%, but once the medication is stopped the myomas will grow back.

Surgical treatment
Myomectomy is a choice to remove myomas. It is usually done when the patient wants to preserve their fertility. This can be performed with either traditional surgery or through laparoscopy.

Total Abdominal or Vaginal hysterectomy with Bilateral Salpingo-oophorectomy is the definitive treatment.