Rare case of coagulative necrosis of uterine leiomyoma: Case report

Abstract

Coagulative tumor necrosis or tumor cell necrosis is a very rare type of fibroid degeneration, commonly occurs in 80% of leiomyosarcomas, but it is rare in benign uterine leiomyomas. Women with menorrhagia have increased levels of plasminogen activators in endometrium and use of anti-fibrinolytics can enhance the formation of thrombus in leiomyoma. Degeneration like red and hyaline in uterine leiomyomas may be associated with pregnancy and use of progestogen or OCP’s but degeneration associated with use of anti-fibrinolytics can occur in any part of reproductive life. Materials and Methods: We present the case of 28yr lady with heavy menstrual bleeding and severe dysmenorrhea since 2 years, diagnosed with fibroid uterus and was on anti-fibrinolytics (Tranexamic acid) on and off for 2years. Finally underwent a myomectomy, wherein we found a cheesy degenerative material with final histopathology report revealing as coagulative tumor necrosis without any atypical cells. Conclusion: Coagulative necrosis is usually seen in malignant condition. Infarct type necrosis and thrombus was observed in benign leiomyoma, possibly secondary to prolonged, repetitive use of Tranexamic acid.