In the event of doubt the case should be watched for a few months until the diagnosis becomes clear. Fibroid tumors are of slow growth, and such delay is usually not dangerous.
If the fibroid tumor is complicated with pregnancy, the diagnosis becomes more difficult. This complication is not an unusual one, and should always be borne in mind.
The differential diagnosis between uterine fibroid and ovarian cyst is easy except in the case of the fibro-cystic tumor. Such tumors have very often been mistaken for ovarian cysts. The mistake is not at all serious, as celiotomy is indicated in either case. The operator, however, should always determine the nature of the tumor before proceeding with the operation after the abdomen has been opened, as puncture of a fibro-cystic tumor may be attended by alarming hemorrhage.
A small fibroid in the posterior wall of the uterus has often been mistaken for retroflexion, and the woman has been treated with a pessary. This mistake may be avoided by feeling, with the abdominal hand, the fundus uteri in its normal forward position, or by determining the true direction of the uterus with the uterine sound.
The prognosis of uterine fibroids may be determined from a consideration of the natural history, the degenerations, and the complications of these neoplasms, which have already been described.
Fibroid tumors are benign growths, in contradistinction to cancer and sarcoma. They do not infiltrate contiguous structures or invade the general system; but they are not benign in the sense that they are not dangerous to life.
As has been said, the disease may terminate as a uterine polyp, which may be discharged from the body. But during this process the woman may die from hemorrhage or from septic absorption from the sloughing, disintegrating tumor.
Some unusual fibroids give no trouble whatever, never attain a large size, and are discovered only accidentally during the life of the woman or at the autopsy.
In very exceptional cases—so rare that they are to be looked upon as medical curiosities—the fibroid disappears spontaneously even after it has reached a large size. This has occurred as the result of an accident, exploratory celiotomy, and pregnancy.
We have no right in any case, however, to look for such favorable termination.