Article: Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: A clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas

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TitleTranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: A clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas
AuthorsIp, PPC1
Lam, KW1
Cheung, CL1
Yeung, MCW1
Pun, TC1
Chan, QKY1
Cheung, ANY1
Issue Date2007
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ajsp.com
CitationAmerican Journal Of Surgical Pathology, 2007, v. 31 n. 8, p. 1215-1224 [How to Cite?]
DOI: http://dx.doi.org/10.1097/PAS.0b013e318032125e
AbstractINTRODUCTION: Women with menorrhagia have increased levels of plasminogen activators in the endometrium. Tranexamic acid (cyklokapron), an antifibrinolytic agent, is commonly prescribed worldwide to women with menorrhagia, including those with fibroids. Necrosis in uterine leiomyomas may be associated with pregnancy, and progestogen or oral contraceptive use but its association with tranexamic acid has not been investigated. Four hundred ninety patients with uterine leiomyomas in 2004 and 2005 were reviewed. Their ages ranged from 22 to 86 (mean 47.2). One hundred forty-seven (30%) were treated with tranexamic acid. RESULTS: Infarct-type necrosis was observed in the leiomyomas of 38 patients, 22 of whom had tranexamic acid (15%) whereas the remaining 16 had no drug exposure (4.7%) (odds ratio=3.60; 95% confidence interval: 1.83-6.07; P=0.0003). Two patients who took the drug less than 2 weeks before surgery had early infarcts with appearance resembled coagulative type necrosis. Eleven of the 22 cases of drug-induced necrotic leiomyoma (50%) also showed intralesional thrombus formation, and 4 showed organization of the thrombi. CONCLUSIONS: Infarct-type necrosis and thrombosis of leiomyoma was more commonly observed in patients treated with tranexamic acid. Although the drug is effective for menorrhagia, clinicians should be aware of the possible complications associated with leiomyoma necrosis such as pain and fever. Distinguishing between types of necrosis may not always be straightforward particularly in early infarcts when the reparative connective tissue reaction between the viable and necrotic cells is not well-developed, resulting in an appearance similar to coagulative necrosis. When the overall gross and microscopic features of a leiomyoma with coagulative necrosis favor a benign lesion, the drug history should be reviewed so that this type of early and healing infarct-type necrosis is considered as the underlying cause of the apparent coagulative necrosis. This may otherwise result in a diagnosis of smooth muscle tumor of uncertain malignant potential, leading to prolonged follow-up and unnecessary further surgical intervention. © 2007 Lippincott Williams & Wilkins, Inc.
ISSN0147-5185
2011 Impact Factor: 4.352
2011 SCImago Journal Rankings: 0.438
DOIhttp://dx.doi.org/10.1097/PAS.0b013e318032125e
ISI Accession Number IDWOS:000248400800012
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorIp, PPC
dc.contributor.authorLam, KW
dc.contributor.authorCheung, CL
dc.contributor.authorYeung, MCW
dc.contributor.authorPun, TC
dc.contributor.authorChan, QKY
dc.contributor.authorCheung, ANY
dc.date.accessioned2010-10-31T11:05:25Z
dc.date.available2010-10-31T11:05:25Z
dc.date.issued2007
dc.description.abstractINTRODUCTION: Women with menorrhagia have increased levels of plasminogen activators in the endometrium. Tranexamic acid (cyklokapron), an antifibrinolytic agent, is commonly prescribed worldwide to women with menorrhagia, including those with fibroids. Necrosis in uterine leiomyomas may be associated with pregnancy, and progestogen or oral contraceptive use but its association with tranexamic acid has not been investigated. Four hundred ninety patients with uterine leiomyomas in 2004 and 2005 were reviewed. Their ages ranged from 22 to 86 (mean 47.2). One hundred forty-seven (30%) were treated with tranexamic acid. RESULTS: Infarct-type necrosis was observed in the leiomyomas of 38 patients, 22 of whom had tranexamic acid (15%) whereas the remaining 16 had no drug exposure (4.7%) (odds ratio=3.60; 95% confidence interval: 1.83-6.07; P=0.0003). Two patients who took the drug less than 2 weeks before surgery had early infarcts with appearance resembled coagulative type necrosis. Eleven of the 22 cases of drug-induced necrotic leiomyoma (50%) also showed intralesional thrombus formation, and 4 showed organization of the thrombi. CONCLUSIONS: Infarct-type necrosis and thrombosis of leiomyoma was more commonly observed in patients treated with tranexamic acid. Although the drug is effective for menorrhagia, clinicians should be aware of the possible complications associated with leiomyoma necrosis such as pain and fever. Distinguishing between types of necrosis may not always be straightforward particularly in early infarcts when the reparative connective tissue reaction between the viable and necrotic cells is not well-developed, resulting in an appearance similar to coagulative necrosis. When the overall gross and microscopic features of a leiomyoma with coagulative necrosis favor a benign lesion, the drug history should be reviewed so that this type of early and healing infarct-type necrosis is considered as the underlying cause of the apparent coagulative necrosis. This may otherwise result in a diagnosis of smooth muscle tumor of uncertain malignant potential, leading to prolonged follow-up and unnecessary further surgical intervention. © 2007 Lippincott Williams & Wilkins, Inc.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationAmerican Journal Of Surgical Pathology, 2007, v. 31 n. 8, p. 1215-1224 [How to Cite?]
DOI: http://dx.doi.org/10.1097/PAS.0b013e318032125e
dc.identifier.doihttp://dx.doi.org/10.1097/PAS.0b013e318032125e
dc.identifier.epage1224
dc.identifier.hkuros173267
dc.identifier.hkuros132902
dc.identifier.isiWOS:000248400800012
dc.identifier.issn0147-5185
2011 Impact Factor: 4.352
2011 SCImago Journal Rankings: 0.438
dc.identifier.issue8
dc.identifier.pmid17667546
dc.identifier.scopuseid_2-s2.0-34547614772
dc.identifier.spage1215
dc.identifier.urihttp://hdl.handle.net/10722/124991
dc.identifier.volume31
dc.languageeng
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ajsp.com
dc.publisher.placeUnited States
dc.relation.ispartofAmerican Journal of Surgical Pathology
dc.relation.referencesReferences in Scopus
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshAntifibrinolytic Agents - adverse effects
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshInfarction - chemically induced - pathology
dc.subject.meshLeiomyoma - complications - drug therapy - pathology
dc.subject.meshMenorrhagia - drug therapy - etiology - pathology
dc.subject.meshMiddle Aged
dc.subject.meshNecrosis
dc.subject.meshThrombosis - chemically induced - pathology
dc.subject.meshTranexamic Acid - adverse effects
dc.subject.meshUterine Neoplasms - complications - drug therapy - pathology
dc.titleTranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: A clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong