There is not much written about pedunculated uterine fibroids on the internet. Therefore, we wanted to explore this topic on our blog. When comparing sessile vs. pedunculated uterine fibroids, they are not much different in terms of symptoms and treatments, but it is the way in which they are attached to the uterus is what sets them apart. In rare instances, the stalk can become twisted and cause a fibroid torsion. This is an extremely rare occurrence and happens only to pedunculated fibroids.
What Is a Pedunculated Fibroid?
Pedunculated fibroids are fibroids that are attached to the uterus by a thin stem . Think of a lollipop with the fibroid being the round end and the stick the thin connection to the rest of the uterus. Pedunculated fibroids that grow from the outside of the uterus into the pelvis are called pedunculated subserosal fibroids while those that grow towards the uterine cavity are pedunculated submucosal fibroids.
Uterine fibroids are abnormal growths in the uterus affecting two out of three women of fertile age and are even more common in African-American women. They originate from the middle layer of the uterus and consist of smooth muscle cells and connective tissue. A peduncle (stalk) is made of the same smooth muscle cells as fibroid nodes and can vary in diameter from 5 mm to 10 cm. As a rule, the diameter of the stalk is not greater than half of the diameter of the fibroid. If there is no stalk present, the fibroid is defined as a sessile fibroid.
Can You See A Pedunculated Fibroid On An Ultrasound?
Pedunculated fibroids that are attached to the uterus by a thin stalk are often found during an ultrasound, which uses sound waves to create images of the uterus. A transabdominal ultrasound (on the belly) or a transvaginal ultrasound (inside the vagina) can help doctors look at the size of a fibroid, its location, and whether it is attached by a stalk. If the ultrasound does not provide a clear enough image, an MRI may be used to obtain clearer and more detailed pedunculated fibroid pictures.
Are Pedunculated Fibroids Dangerous?
Pedunculated fibroids are not usually concerning other than the symptoms that they may cause. However, in very rare instances, the subserosal fibroid can twist on its thin stem and cut the blood supply off which can cause sudden severe pain. This is called torsion, but again this is very rare but would require medical attention.
A pedunculated fibroid during pregnancy could potentially grow larger due to the increase in hormones. If it is a submucosal pedunculated fibroid, its growth could potentially block the birth canal and trigger an emergency C-section.
Are Pedunculated Fibroid Symptoms Different?
Pedunculated myomas of both submucosal and subserosal locations cause the same symptoms as sessile fibroids in those locations. Located outside of the uterus, pedunculated fibroids might result in pressure and pain in the abdomen. Submucosal pedunculated tumors might be responsible for heavy prolonged periods and fertility issues. A posterior pedunculated fibroid (located on the back of the uterus) can press on nearby nerves, potentially causing lower back pain and leg pain that feels similar to sciatica. A pedunculated fundal fibroid (located on the top part of the uterus) can cause a dull, aching pain, menstrual cramps, or a heavy sensation in the uterus due to its size and position.
Torsion of Pedunculated Fibroids
Very rarely, a sudden or quick movement can cause the stalk on a fibroid to twist interrupting its blood supply. A woman may feel sudden and severe abdominal pain. The pain may not last long but requires immediate medical attention due to the risk of ischemic gangrene.
A torsion is hard to diagnose pre-operatively as the twisted stalk may not be seen on imaging tests. It is for this reason that most cases of fibroid torsion are misdiagnosed and confused with fibroid degeneration which is a much more common condition.
Recent studies suggest an alternate approach to identify twisted pedunculated leiomyomas pre-operatively. A computed tomography (CT Scan) of the pelvis with intravenous contrast material was proposed to check vascularity through the peduncle and the fibroid to determine any interference in blood flow.
Unfortunately, surgery is the only option for a torsed pedunculated fibroid. Laparoscopic myomectomy and hysteroscopic myomectomy are both procedures that can be used to remove twisted pedunculated fibroids.
Is UFE Effective for Fibroids on Stalks?
Uterine fibroid embolization (UFE) is a very effective way to treat symptomatic fibroids; whether they are pedunculated or not. Here’s some important things to know about these fibroids:
- Pedunculated fibroids are unusual.
- Most pedunculated fibroids are actually exophytic which is a broad base of attachment to the uterus and are labeled pedunculated on the radiology report incorrectly due to using the term “pedunculated” incorrectly. The term pedunculated should only be used with respect to a fibroid that is connected to the uterus by a thin stem or stalk. Sometimes, any fibroid that grows away from the uterus is called pedunculated and that is incorrect and lacks a true understanding of the term.
- When pedunculated subserosal fibroids are present, some patients get worried that if they undergo UFE, the fibroid will detach from the uterus and will be loose and “roam free” in the pelvis. In almost 30 years of medical reporting on UFE, there has been less than a single handful of cases that said this occurred to a patient. If there’s at least a 10-mm (1-cm) stalk, that will not happen.
- Atlanta Fibroid Center has been embolizing pedunculated fibroids for over 25 years and has never had an issue in any patient with this type of fibroid.
Here are more studies on pedunculated fibroids. For more information about pedunculated uterine leiomyomas, or any other type, book a consultation with the fibroid expert Dr. John Lipman from Atlanta Fibroid Center by calling (770) 953-2600 or using an online submission form.
