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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

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
Authors
KeywordsEarly infarct
Leiomyoma
Menorrhagia
Necrosis
Smooth muscle tumor
Tranexamic acid
Issue Date2007
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ajsp.com
Citation
American Journal Of Surgical Pathology, 2007, v. 31 n. 8, p. 1215-1224 How to Cite?
Abstract
INTRODUCTION: 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.
Persistent Identifierhttp://hdl.handle.net/10722/124991
ISSN
2013 Impact Factor: 4.592
2013 SCImago Journal Rankings: 2.828
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorIp, PPCen_HK
dc.contributor.authorLam, KWen_HK
dc.contributor.authorCheung, CLen_HK
dc.contributor.authorYeung, MCWen_HK
dc.contributor.authorPun, TCen_HK
dc.contributor.authorChan, QKYen_HK
dc.contributor.authorCheung, ANYen_HK
dc.date.accessioned2010-10-31T11:05:25Z-
dc.date.available2010-10-31T11:05:25Z-
dc.date.issued2007en_HK
dc.identifier.citationAmerican Journal Of Surgical Pathology, 2007, v. 31 n. 8, p. 1215-1224en_HK
dc.identifier.issn0147-5185en_HK
dc.identifier.urihttp://hdl.handle.net/10722/124991-
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.en_HK
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ajsp.comen_HK
dc.relation.ispartofAmerican Journal of Surgical Pathologyen_HK
dc.subjectEarly infarcten_HK
dc.subjectLeiomyomaen_HK
dc.subjectMenorrhagiaen_HK
dc.subjectNecrosisen_HK
dc.subjectSmooth muscle tumoren_HK
dc.subjectTranexamic aciden_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAged, 80 and overen_HK
dc.subject.meshAntifibrinolytic Agents - adverse effectsen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshInfarction - chemically induced - pathologyen_HK
dc.subject.meshLeiomyoma - complications - drug therapy - pathologyen_HK
dc.subject.meshMenorrhagia - drug therapy - etiology - pathologyen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshNecrosisen_HK
dc.subject.meshThrombosis - chemically induced - pathologyen_HK
dc.subject.meshTranexamic Acid - adverse effectsen_HK
dc.subject.meshUterine Neoplasms - complications - drug therapy - pathologyen_HK
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 leiomyomasen_HK
dc.typeArticleen_HK
dc.identifier.emailCheung, CL: lung1212@hku.hken_HK
dc.identifier.emailCheung, ANY: anycheun@hkucc.hku.hken_HK
dc.identifier.authorityCheung, CL=rp01749en_HK
dc.identifier.authorityCheung, ANY=rp00542en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/PAS.0b013e318032125een_HK
dc.identifier.pmid17667546en_HK
dc.identifier.scopuseid_2-s2.0-34547614772en_HK
dc.identifier.hkuros173267en_HK
dc.identifier.hkuros132902en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34547614772&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume31en_HK
dc.identifier.issue8en_HK
dc.identifier.spage1215en_HK
dc.identifier.epage1224en_HK
dc.identifier.isiWOS:000248400800012-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridIp, PPC=7003622683en_HK
dc.identifier.scopusauthoridLam, KW=13407245500en_HK
dc.identifier.scopusauthoridCheung, CL=14520953400en_HK
dc.identifier.scopusauthoridYeung, MCW=7101861644en_HK
dc.identifier.scopusauthoridPun, TC=7005509306en_HK
dc.identifier.scopusauthoridChan, QKY=8390404100en_HK
dc.identifier.scopusauthoridCheung, ANY=54927484100en_HK

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