Multiple leiomyoma

Endometrial ablation is a permanent and invasive therapeutic option which relieves excessive menstrual bleeding in 62%-79% of cases [175]. Thermoablation of the endometrium is performed using a balloon or roller ball technique and a hysteroscopic access. The success of endometrial ablation in the presence of fibroids is small since not the entire endometrium is accessible in women with multiple leiomyomas because of enlargement and deformity of the uterine cavity. 

Fig. 5.3. Macroscopic pathology of diffuse leiomyomatosis of the uterus. Macroscopic uterine specimen showing multiple ill-defined leiomyomas throughout all uterine layers ranging from millimeters to several centimeters in size. The leiomyomas are partially confluent and have replaced almost the entire normal myometrium, a condition also known under the term of (diffuse) leiomyomatosis...

Fig. 5.8. MRI of leiomyoma - locations. Transaxial T2-weighted image depicts multiple, mainly subserosal uterine leiomyoma. There is mild distortion of the uterine cavity by a transmural (full thickness) leiomyoma (arrow)...

Fig. 5.12. Polyfibroid uterus - MRI appearance. T2-weighted sagittal image of a 44-year-old women shows multiple uterine leiomyoma, the largest extending subserosal from the fundus of the uterus. All leiomyomas are well marginated and show typical hypointense signal intensity with some speckled hy-perintense spots. A pedunculated subserosally leiomyoma is present in the posterior cul-de-sac...

Polyps are small, smooth, filling defects, which can be single or multiple, and do not distort the overall size and shape of the uterine cavity (Fig. 16.4). Leiomyomas are usually single, larger lobulated masses, which only partially project into the cavity, and often enlarge and distort the cavity (Fig. 16.5). 

The vast majority of leiomyomas in the stomach occur as solitary lesions, but multiple tumours are present in 1-2% of patients. Leiomyomas may be found in the antrum, body, or fundus of the stomach. Gastric leiomyomas may vary in size from tiny lesions of a few millimetres to enormous masses that significantly encroach on the lumen. 

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