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Fibroid with hypervascular areas

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I had a endovaginal sonogram and the and the resulta came as follow: fibroid measuring 9x7x 7.5 . Fibroid is inhomogenous with hypervascular areas. Cannot exclude sarcomatous degeneration. Endometrium appears normal. (6 mm). Normal ovaries . No adnexal masses.

Impression: growing fibroid

I don,t have major symptoms no major bleeding , no pain just sometimes a little presure. What most concerns me is what the doctor mentions cannot exclude sarcomatous degeneration. Please advise.

Category: OBGYN

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Category: Infertility Specialist
 31 Doctors Online

Thanks for writing to with your health concern.

See , even if you are asymptomatic , the fibroid of the specified dimensions mandates removal. It is not going to regress on its own.

Now, the complicating factor is the term - sarcomatous degeneration. Fibroids can undergo lots of internal changes - vascularization, degneration, cystic changes etc. Sarcomatous changes are those that are suggestive of a malignancy - these are very rare, only 1 in 1000.

Your sonogram is suggestive of that, not diagnostic.
The only confirmatory proof would be removal of the said fibroid and then a formal histopathology ( biopsy ) which would tell you for sure if malignant changes had set in.

There is nothing to worry about, since in any case, the fibroid would be removed by then. So please plan for surgical removal.

All the best. Would be glad to answer any follow-ups.
Take care.

Patient replied :

What surgery alternatives should i proceed with.? Can this wait or i should do this immediately? Can i proceed with a minimal invasive surgery? I will not like a hysterectomy. What will be the recovery time approximately? I also thought that because i am close to menopause that there a possibility that this can shrink?

Yes, fibroids can shrink with menopause, but not one of this size, and especially one showing suspicion of sarcomatous degeneration.

You can wait a few days but not months.
Yes, laparoscopic minimally invasive surgery can be tried.

Since this is one single fibroid, you can opt for myomectomy done laparoscopically ( removal of the fibroid only ) instead of a complete hysterectomy.

The recovery time, in expert hands, would be a few days in the hospital, and full resumption of normal functions in 4 - 6 weeks time.

Take care.

Patient replied :

Thanks so much for your opinion i need to look for the best doctor to do this so i believe it will take me like two to three weeks to make this search. My daugther is a third year med student and she is going to send me the name pf a good doctor Will this be top long to wait

Yes, you can take two or three weeks time for sure.
Wish you good health.

Patient replied :

My doctor is suggesting a biopsy of the endometrium first before surgery. But she definitely says that surgery needs to be done

That must be because you are so reluctant to have a hysterectomy.
When sarcomatous change is indicated in a fibroid, he / she is right to insist on an endometrial biopsy to ensure that the rest of the uterus is alright.

Dr. Aarti Vazirani
Category: Infertility Specialist
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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