In Reply to: Re: Case 0100_02 -- Pedunculated Serosal Fibroid posted by George A. Fueredi on January 03, 19100 at 22:48:22:
I'm not sure that these need to be avoided. I have performed UAE on several patients with obvious pedunculated subserosal fibroids (including one woman who could manually shift her fibroid form side to side) with no evidence of such a complication. The stalk is not necessarily myoma tissue and will probably not necrose (since normal myometrium and uterine serosa are both unharmed by UAE.
Even if a myoma did "fall off" into the peritoneal cavity, it is uncertain whether or not this would cause symptoms. Pieces of myoma are commonly lost in the peritoneal cavity during laparoscopic myomectomy of hysterectomy and rarely cause symptoms (in fact, I am in the process of publishing a case report which is unusual because the fragment did cause symptoms).
In this case the presence of the cystic changes within the myoma are worrisome findings, and I would not embolize this patient because the lesion may not be a simple benign leiomyoma. However, if there were no such cystic changes I would probably do the UAE. I would, however, be sure to discuss these issues with the patient - so that we can watch out for an event such as the stalk necrosing and allowing the fibroid to "fall off" the uterus.