There is not much information regarding pedunculated uterine fibroids available on the internet. Therefore, we wanted to explore this topic on our blog. Pedunculated uterine leiomyomas are not much different from sessile fibroids in terms of symptoms and treatments but the manner 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 grow on peduncles (stems or stalks) attached to 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.
Are Symptoms of Pedunculated Leiomyomas 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.
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 can 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 more common occurrence.
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?
If pedunculated myomatas are asymptomatic, treatment is typically not required. However, as mentioned above, there is a low risk of pedunculated fibroid torsion. Therefore, a woman with a pedunculated myoma might consider undergoing non-invasive treatment such as uterine fibroid embolization (UFE).
Several studies have been conducted to analyze the safety and effectiveness of uterine fibroid embolization (UFE) in treating pedunculated leiomyomas. Neither increased risks nor complications were identified to be associated with UFE performed on patients with pedunculated myomas.
Embolic agents injected intravenously during the UFE procedure block the blood supply to pedunculated tumors and cause their shrinkage. Peduncles also reduce in diameter after embolization.
For more information about pedunculated uterine leiomyomas, or any other type, book a consultation with a fibroid expert Dr. John Lipman from Atlanta Fibroid Center by calling (770) 953-2600 or using an online submission form.