Fibroid Degeneration

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February 20, 2023

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Have you ever heard of fibroid degeneration? Uterine fibroids are a global health problem. Uterine fibroids affect 40% of women over 35 years of age. It is a benign neoplasm made up of smooth muscle. So what is degenerating fibroid? In most cases, the fibroid is shown with typical images, but the fibroid degeneration can confuse when establishing the diagnosis or the given morphology of the tumour.

Signs of fibroids breaking down

Uterine fibroids are common neoplasms and appear in 70% of women aged 45. They are usually classified according to their location in the myometrium and can be subserous (more common), intramural, transmural and submucosal (less common). Fibroids sometimes appear in the broad ligament, fallopian tubes, or cervix, and because they respond to estrogen, they tend to enlarge during the reproductive years and shrink after menopause.

There are different morphological variants. The signs of fibroids breaking down can be witnessed in the arrangement and appearance of cellularity, number of mitoses and relationship with blood vessels that are compromised according to the growth of fibroids. These alterations occur in 30% of cases and can appear at any age, but their maximum frequency occurs after 40 years of age.

How to spot degenerating fibroid?

Degenerating fibroid is a frequent phenomenon in fibroids, especially the more significant the fibroids, such as stroke and atrophy, which almost always begins after menopause. Fibroid degeneration occurs in 60% of tumours. The most common degenerative change can involve:

Areas or the entire tumor.
Assuming a pale, homogeneous appearance.
Blurring the swirling pattern in areas.

A particular form is red degenerating fibroid (generally appearing only during pregnancy and is clinically manifested by acute abdominal pain). In the long term, red fibroid degeneration can develop peripheral calcification more frequently in older women (menopause). Another rare form a fibroid can undergo is necrosis, seen on macroscopic examination as a pale grey, softened mass, which occurs in approximately 10% of all fibroids. Necrosis may appear in connection with menstruation, but most frequently, it happens during pregnancy.

Degenerating fibroid is quite frequent to observe in a focal way. On other occasions, this degeneration occurs diffusely within the fibroid, which can result in different morphological patterns, such as:

peri nodular hydropic change
Hydropic change that extends outside the confines of the leiomyoma, resembling a myxoid leiomyosarcoma and
Extensive or subtotal replacement of the leiomyoma by hydropic tissue accompanied by numerous vessels that obscure the myoid nature of the tumor.

However, this type of change is sometimes very intense and can form cystic cavities, becoming a cystic fibroid degeneration that occurs in approximately 4% of uterine fibroids.

All these alterations and variants can sometimes be confused with the malignant counterpart of smooth muscle tumors, or with tumors of another histological excision. The fibroids most susceptible to undergoing this change are submucosal fibroids.

Risk factors for uterine fibroids

Race: incidence is higher in black and Asian women than in white women; the most common are multiple fibroids.

Heredity: the risk is higher in women with first-degree relatives who have fibroids.
Age: the incidence increases with age.
Pregnancy: full-term pregnancy is associated with lower rates of fibroids; fibroids are more common in nulliparous women.
Hormonal contraception: progestin-only injectable hormonal contraceptives and oral contraceptives reduce the risk of fibroids.
Obesity: weight gain and central distribution of body fat increase the risk of fibroids.

How do women refer to signs of fibroids breaking down?

Women with symptomatic fibroids that do not respond to initial treatments require referral to signs of fibroids breaking down. Some may be candidates for newer uterine-sparing treatments if preferred. Because fibroids generally do not cause irregular bleeding, their presence indicates prompt referral, as do the other symptoms or signs listed in the following table.