Can Fibroids Be Malignant?

Can fibroids be malignant?

Leiomyosarcaomata are very rare (being found in 2-5 per thousand hysterectomy specimens) and only 3% have a history of rapid growth. Size, imaging appearance and growth rate do not indicate malignancy. Fear of malignancy should not normally be used to justify hysterectomy which itself has a mortality rate of 1-6 per thousand.

How safe is UFE?

UFE is a minimally invasive procedure. Overall, the rate of UFE complications is very low, and most complications are transient. Transcervical leiomyoma tissue passage is the most common complication requiring transcervical removal; it occurs in approximately 2.5% of patients. This could be reduced by careful patient selection to exclude submucosal pedunculated fibroids, or those with a significant intracavitary component.

The most serious UFE complication is endometritis, with a reported incidence of 2%. This is can be managed with prompt administration of antibiotics and removal of sloughed fibroid if present.

The rate of hysterectomy subsequent to UFE ranges between 0.25% and 1.6% and is generally attributable to infection, pain, and bleeding.

Is UFE painful?

The procedure itself is not painful. Post procedural pain is worst in the first few hours and is managed with paracetamol, NSAID and patient controlled narcotic analgesia. Low-grade fever, nausea and vomiting, lethargy and minor vaginal discharge are common post embolisation symptoms. Patients should expect to return to normal activities in one week.

Is there local Australian data?

Yes, in 2012 we published in ANZJOG the first Australian series of 75 UFEs, achieving a 96% success rate for menorrhagia, 93% overall patient satisfaction, and improvement of dysmenorrhea in 89%.

Can a woman loose her period after UFE?

Yes, but this is more likely to be coincidental with natural menopause. UFE does not appear to affect ovarian function in younger women; permanent amenorrhea tends to occur in older women close to natural menopause.

Is pregnancy possible after UFE?

Yes, and the birth weights were shown to be not affected by prior UFE. Women requiring UFE are usually hysterectomy candidates with grossly abnormal uterus to start with. As one would expect, when compared with normal obstetric population, there is higher rate of miscarriage, caesarean section and postpartum haemorrhage. Currently a randomised control trial is being conducted in UK to compare fertility outcomes between UFE and myomectomy. In the mean time we recommend MRI to study fibroid anatomy. We would consider UFE if myomectomy is technically challenging and its outcome is likely to be unfavourable for pregnancy, or if the woman prefers a non-surgical approach.

Can adenomyosis and adenomyoma be treated by UAE?

Yes, we have 90% clinical success in alleviating symptoms of menorrhagia and dysmenorrhea. These conditions are usually missed or misdiagnosed on ultrasound. MRI is the most reliable imaging test. Smaller embolic particles are used to treat adenomyosis and adenomyoma.

Who are the ideal candidates for UFE/UAE?

Women significantly troubled by fibroid or adenomyosisrelated symptoms such as menorrhagia, dysmenorrhea and bulk symptoms, desiring to avoid major surgery, preferring a minimally invasive approach and faster recovery. Condoleezza Rice is a good example.