SECONDARY DEGENERATIONS IN FIBROIDS
Hyaline degeneration: It is the most common (65%)type of degeneration affecting all sizes of fibroids except the tiny one. It is common specially in tumors having more connective tissues. The central part of the tumor which is least vascular is the common site. The feel becomes soft elastic in contrast to firm feel of the tumor. Naked eye examination on the cut surface shows irregular homogenous areas with loss of whorl-like appearance. Microscopic examination reveals hyaline changes of both the muscles and fibrous tissues.
Cystic degeneration: - usually occurs following menopause and is common in interstitial fibroids. It is formed by liquefaction of the areas with hyaline changes. The cystic spaces are lined by irregular ragged walls. The cystic changes of an isolated big fibroid may be confused with an ovarian cyst or pregnancy.
Fatty degeneration: It is usually found at or after menopause. Fat globules are deposited mainly in the muscle cells.
Calcific degeneration (10%) usually involves the subserous fibroids with small pedicle or myomas of postmenopausal women. It is usually preceded by fatty degeneration. There is precipitation of calcium carbonate or phosphate within the tumor. When whole of the tumor is converted into a calcified mass, it is called “womb stone”.
Red degeneration: - (carneous degeneration) occurs in a large fibroid mainly during second half of pregnancy and puerperium. Partial recovery is possible and as such called necrobiosis. The cause is not known but is probably vascular in origin. Infection does not play any part.Naked eye appearance of the tumor shows dark areas with cut section revealing raw-beef appearance often containing cystic spaces. The odor is often fishy due to fatty acids. Color is due to the presence of hemolysed red cells and hemoglobin. Microscopically, evidences of necrosis are present. Vessels are thrombosed but extravasation of blood is unlikely.
Atrophy: Atrophic changes occur following menopause due to loss of support from estrogen. There is reduction in the size of the tumor. Similar reduction also occurs following pregnancy enlargement.
Necrosis: Circulatory inadequacy may lead to central necrosis of the tumor. This is present in submucous polyp or pedunculated subserous fibroid.
Infection: The infection gains access to the tumor core through the thinned and sloughed surface epithelium of the submucous fibroid. This usually happens following delivery or abortion. Intramural fibroid may also be infected following delivery.
Vascular changes: Dilatation of the vessels (telangiectasis) or dilatation of the lymphatic channels (lymphangiectasis) inside the myoma may occur. The cause is not known.
Sarcomatous changes: Sarcomatous change may occur in less than 0.1 percent cases. The usual type is leiomyosarcoma. Recurrence of fibroid polyp, sudden enlargement of fibroid or fibroid along with postmenopausal bleeding raises the suspicion.
ASSOCIATED CHANGES IN THE PELVIC ORGANS: -
Uterus: The shape is distorted; usually asymmetrical but at times, uniform. Myohyperplasia is almost a constant finding. It may be due to hyperestrinism or work hypertrophy in an attempt to expel the fibroid. The endometrium may be of normal type. In others, there are features of anovulation with evidences of hyperplasia. There is dilatation and congestion of the myometrial and endometrial venous plexuses. The endometrium as a result becomes thick, congested and edematous. The endometrium overlying the submucous fibroid may be thin and necrotic with evidences of infection.
Uterine tubes: The frequent tubal infection (about 15%) detected in association with fibroid seems coincidental.
Ovaries: The ovaries may be enlarged, congested and studded with multiple cysts. The cause may be due to hyperestrinism.
Ureter: There may be displacement of the anatomy of the ureter in broad ligament fibroid. The compression effect results in hydroureter and or hydronephrosis.
Endometriosis: There is increased association of pelvic endometriosis and adenomyosis (30%). Endometrial carcinoma: The incidence remains unaffected.
HOMOEOPATHIC MEDICINES FOR MANAGING SECONDARY CHANGES IN FIBROIDS
Some other used medicines are: -