Handwritten medical notes on a white lined notebook page about Uterine Fibroid (Leiomyoma). The notes should look like neat handwritten student notes with headings underlined, bullet points, arrows and small diagrams. Include the following sections clearly: UTERINE FIBROID (LEIOMYOMA) Definition: Benign monoclonal smooth muscle tumour of the myometrium. Most common tumour in females. Also called "fibroid" or "myoma". Epidemiology: Reproductive age women. More common in African-Caribbean women. Shrink after menopause (estrogen/progesterone dependent). Genetics / Pathogenesis: • MED12 gene mutations ~70% • Chromosomal rearrangements – 6p, 12q14 (HMGIC, HMGIY genes) • Estrogen + progesterone stimulate growth • Fumarate hydratase (FH) gene – HLRCC syndrome Types (with small uterus diagram showing locations): • Intramural – within myometrium (most common) • Submucosal – beneath endometrium → heavy bleeding, infertility • Subserosal – beneath serosa → pressure symptoms; if pedunculated → mimics ovarian mass • Cervical / Broad ligament (rare) Morphology: • Well-circumscribed, firm, grey-white, whorled cut surface • Uniform smooth muscle cells, oval nuclei, scarce mitoses • Variants: cellular, bizarre nuclei, IV leiomyomatosis, disseminated peritoneal Degeneration types (small list with arrows): Hyaline → Cystic → Calcific → Red (carneous) – in pregnancy → Myxoid Clinical Features: • Menorrhagia ± metrorrhagia (most common symptom) • Anaemia (iron deficiency) • Pressure symptoms: urinary frequency/retention, constipation, backache • Infertility / recurrent pregnancy loss (submucosal) • Acute pain: torsion of pedunculated fibroid, red degeneration • Many patients ASYMPTOMATIC Investigations: • Pelvic USS (1st line) – hypoechoic, well-defined spherical mass • MRI pelvis – if USS inconclusive / pre-surgical planning • FBC (anaemia), coagulation screen Treatment: Conservative: observation if asymptomatic Medical: Tranexamic acid, NSAIDs, COCP, LNG-IUS (Mirena) Hormonal: GnRH agonists (leuprolide) – shrink fibroids pre-op; Ulipristal acetate Surgical (uterus-sparing): Myomectomy (open/laparoscopic/hysteroscopic for submucosal) Surgical (definitive): Hysterectomy Interventional: Uterine artery embolisation (UAE) Complications in Pregnancy: Red degeneration, malpresentation, preterm labour, PPH, ↑ risk placenta praevia/abruption Malignant transformation → Leiomyosarcoma (EXTREMELY RARE < 1%) The handwriting style should be neat, blue ink on white lined paper, with red ink for headings and key terms, small anatomical sketches of uterus cross-section showing fibroid locations.

Neat handwritten medical student notes on white lined notebook paper about Uterine Fibroid. Blue ballpoint pen handwriting, red pen for main headings and key terms underlined. The notes are organized, clean, and detailed like a medical student's study notes. Layout: Title (red, large, underlined): UTERINE FIBROID (LEIOMYOMA) Section 1 - DEFINITION & EPIDEMIOLOGY (red, underlined): - Benign monoclonal smooth muscle tumour of the myometrium - Most common tumour in females (reproductive age) - More common in African-Caribbean women - Estrogen + progesterone dependent → shrink post-menopause - Prevalence: 3–4% detected on mid-trimester USS Section 2 - GENETICS / PATHOGENESIS (red, underlined): - MED12 gene mutation (~70%) — regulates RNA polymerase - Chromosomal rearrangements: 6p (HMGIY), 12q14 (HMGIC) - HLRCC syndrome: germline FH (fumarate hydratase) mutation - Monoclonal origin; estrogen/progesterone receptor positive Section 3 - TYPES / LOCATIONS (red, underlined): [Small diagram of uterus cross-section with labels] • Intramural (most common) – within myometrium • Submucosal – under endometrium → heavy bleeding, infertility • Subserosal – under serosa → pressure symptoms • Pedunculated – on a stalk (subserosal or submucosal) • Rare: cervical, broad ligament Section 4 - MORPHOLOGY (red, underlined): Gross: Firm, grey-white, whorled cut surface, well-circumscribed Micro: Bundles of uniform smooth muscle cells, oval nuclei, scarce mitoses Variants: cellular, bizarre nuclei, IV leiomyomatosis, disseminated peritoneal Section 5 - DEGENERATION TYPES (red, underlined): Hyaline → Cystic → Calcific → Red/Carneous (pregnancy) → Myxoid → Sarcomatous (rare) Section 6 - CLINICAL FEATURES (red, underlined): • Menorrhagia ± metrorrhagia (most common) • Anaemia (iron deficiency) • Pressure: urinary frequency/retention, constipation, backache • Infertility / recurrent pregnancy loss (submucosal) • Acute pain: torsion, red degeneration • Many asymptomatic! Section 7 - INVESTIGATIONS (red, underlined): • Pelvic USS (1st line) – hypoechoic, well-defined spherical mass • MRI pelvis – if USS inconclusive / pre-surgical planning • FBC (anaemia), coagulation screen, LFTs Section 8 - TREATMENT (red, underlined): Conservative: observation if asymptomatic Medical: Tranexamic acid, NSAIDs, COCP, LNG-IUS (Mirena) Hormonal: GnRH agonists (leuprolide) – pre-op shrinkage Surgical (uterus-sparing): Myomectomy Surgical (definitive): Hysterectomy Interventional: UAE (Uterine Artery Embolisation) Section 9 - PREGNANCY COMPLICATIONS (red, underlined): Red degeneration, malpresentation, preterm labour, PPH, placenta praevia (OR 2.2), abruption (OR 2.6) IMPORTANT (circled in red): Malignant transformation → Leiomyosarcoma EXTREMELY RARE (<1%)