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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
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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
 
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
 
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
2012 Impact Factor: 4.868
2012 SCImago Journal Rankings: 2.139
 
DOIhttp://dx.doi.org/10.1097/PAS.0b013e318032125e
 
ISI Accession Number IDWOS:000248400800012
 
ReferencesReferences in Scopus
 
DC FieldValue
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
2012 Impact Factor: 4.868
2012 SCImago Journal Rankings: 2.139
 
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.subjectEarly infarct
 
dc.subjectLeiomyoma
 
dc.subjectMenorrhagia
 
dc.subjectNecrosis
 
dc.subjectSmooth muscle tumor
 
dc.subjectTranexamic acid
 
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
 
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Author Affiliations
  1. The University of Hong Kong