Two Women, Severe Anemia, One had a Myomectomy, the other Embolization (UFE)

June 14, 2011

At the time I was starting this blog two patients with similar fibroids came to see me. Both were severely anemic, and one was hemorrhaging and in shock.

At the time I was starting this blog two patients with similar fibroids came to see me. Both were severely anemic, and one was hemorrhaging and in shock.
Before any procedure was done I received both patients’ permission to share their stories.  At the time of the initial writing one had treatment 6 weeks ago and one 3 weeks ago.  Neither of their experiences to date are necessarily typical, but I am following through on my commitment to share their stories.

Comment:   (Updated 6-17-2010)
Yesterday was a difficult day. We did surgery on my first patient (who had the embolization) and found a high-grade sarcoma (cancer) which had spread throughout the abdomen.
I talked to her about deleting her story, but she was comfortable with leaving it in.  Uterine sarcoma is very uncommon, being seen in fewer than 1 in 500 rapidly growing fibroids. The risk of cancer is much lower for fibroids that are not rapidly growing. Benign fibroids have never been shown to undergo malignant change.

Could this have been diagnosed earlier, and if so would it have made a difference? Probably not.  There is a single study in which a blood test coupled with a special MRI done with IV contrast rapidly infused differentiated between sarcoma and fibroids.  To my knowledge this has not been confirmed by other studies, and by the time the tumor can be diagnosed there is a high probability that it would have already spread.

It is easy to overreact and be overly aggressive in removing fibroids because of the fear of cancer, which is in fact rare. We would be doing hundreds of unnecessary surgeries to find a single sarcoma.  Yes, had she chosen myomectomy or hysterectomy, we would have diagnosed her sarcoma two months earlier, but it is unlikely that the outcome would be different.  I was tempted to remove this story for fear that it would frighten women into surgery that is not needed.  But I promised to tell the story as it is.  Please understand that this is very unusual, and most women do well when embolization is done in appropriate situations.  - Paul Indman, M.D

First Visit 

Jan, a 41 year old woman with heavy periods, came for her first visit, and was not actively bleeding. She was short of breath and weak, but not in shock. Her hemoglobin was 5.0. Jan would like to have another baby.

Findings at first visit 
Uterus the size of a 16 week pregnancy.Uterus the size of a 18 week pregnancy.
Initial treatment 
Hospitalized, transfused 4 units of blood.Started on high dose birth control pills to prevent further bleeding. Given medication and iron to build up blood.
Decision making: 

As Jan wants to have another baby, she chose to have the fibroid removed. Given the size and location, I felt an abdominal myomectomy would allow the best repair of the uterus.

 

 

Treatment 

Below is from her actual embolization done by an interventional radiologist, and shows the catheter in the right side. The blood vessels appear black.

 

 

Fibroid (above) being removed from uterus (below)

Fibroid measures 15cm. (6 inches). Two smaller fibroids were also removed.

2 weeks after procedure: 

Low grade fever, chills, vaginal bleeding


 

4 weeks after procedure: 
Bleeding a pad every 3-4 hours.At time of this writing it is not yet 4 weeks since Jan's myomectomy. I'll post her progress  
6 weeks after procedure: 
Uterus has increased to size of 22 week pregnancy and is tender. MRI and CT scan ordered. Results: large mass with large abdominal lymph nodes suggesting malignancy. 
Findings at surgery:Four month check-up after Jan's abdominal myomectomy

Editor's Note: This post was picked up from Uterine Fibroids blog: An Expert Speaks Out.The blog posts do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only