Teresa aged
16 of Italian decent came to see me in my consulting rooms with her dad, they
were both very irate. Her dad was told by her GP that she may be pregnant;
however she denied it with great anger. She was well developed, very understanding and
knew what he was talking about. I advised them to sit down and calm down. The only
problem she had was a sizeable lump on her belly, and she had to go to the toilet
frequently, which was a nuisance particularly during school. I examined her in
my office. It did not take me more than a few seconds to know what it was. Besides
that she had an intact hymen. So the question of pregnancy did not arise. I
told them it was a uterine fibroid, which was about the size of a football. I
also explained to them that although the fibroids are the commonest tumours in
women between the ages of 35 T0 50, the percentage quoted in the
literature varied between 35 to 50%. I had seen one case of fibroid tumour about
5 years earlier in a girl aged 15. These tumours are very rare in teenagers; however
I think Teresa had a fibroid. Teresa’s
pregnancy test was negative which reassured him. There was no ultrasound in
those days. Her dad was happy that she was not pregnant and requested that I treat
her. So far in the last 50 years only 19 cases of teenage girls with fibroids (they
are also called myomas) are reported in English literature. I am sure there
will be a few more. I did not report this case, as I did not have the facility
to do so. However I never saw another case in my 55 years of practicing as a
gynaecologist.
The most
common treatment in those days and even now is a simple operation called myomectomy.
This means removal of the fibroid or fibroids, depending on if there is more
than one. This does not disturb the young girl’s reproductive function. In some
cases the fibroids are reported to have reoccurred, than another myomectomy is
performed. The risk of myomas being cancerous is very rare. It has been
estimated to be one in 1000.No malignancy was reported in the 19 cases described
in literature. I performed a myomectomy on Teresa. From then on I saw Teresa every
6 months. Later on when ultrasound became available, then I used this for
Teresa on her subsequent visits. I was very lucky during my active practice
years that she had two pregnancies, and I delivered two lovely boys for her by caesarean
section without any trouble. It is mandatory to deliver babies by caesarean section
after myomectomy. Labour can damage the uterus. 30 years down the track I still
see her some times.
These days
the treatment of fibroids has improved. There are many drugs we can use to
decrease the size of fibroids so that myomectomy and hysterectomy become
easier, there is less blood loss, recovery is easier. The other technique is uterine artery embolization,(
UAE )this means the blood to the uterus is impeded, then less blood goes to the
fibroid and it dies. Both these types of treatment are not offered to teenagers
although recently a 12 year old girl with fibroid and severe bleeding as well as
a Bleeding Disorder had an UAE.
The latest
is a new machine which uses a very high intensity focussed ultra sound in conjunction
with an MRI. After detailed assessment of the women and detailed preparation it
kills the fibroid. If the fibroid is a very large one it requires more than one
focussed area. This has not been used in teenage woman with fibroids so far. The Royal Women’s Hospital in Melbourne,
Australia has the one and only machine for this method of treatment.
In
conclusion never exclude fibroids if a young girl presents with a pelvic mass
Teresa never had any other gynaecological problems
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