Hormonal Therapy and Associated Degenerative Changes, Cytologic Atypia, and Mitotic Activity in Uterine Leiomyomas: A Clinicopathologic Study of 875 Cases
Bradley M. Turner MD, MPH, MHA and Fattaneh A. Tavassoli, MD
Department of Pathology, Yale School of Medicine, New Haven, CT, USA
ABSTRACT
Degenerative changes (myxedema, ischemia / necrosis / infarction), increased mitotic activity (MA), and/or cytologic atypia (CA) have been observed in uterine smooth muscle tumors in association with oral contraceptive (OC) use. We compared the presence of these changes in leiomyomas (LMs) with and without an associated history of hormonal therapy (HT). A total of 875 cases, including 733 hysterectomies and 142 myomectomies, were eligible for the study. Of the 211 cases on HT, 49 (23.2%) had degenerative changes (DC) compared to 87 of the 664 (13.1%) cases that were not on HT within 3 months of surgery. HTs included combination progesterone/estrogen (102), single agent (SA) progesterone (17), estrogen (29), leuprolide acetate (46) and Tamoxifen (17). Prior HT was significantly associated with DC only in Lo-Estrin (Lo-E), leuprolide acetate (LA), and medroxy-progesterone (MP). Prior HT was significantly associated with increased MA and CA only in Lo-E. Hormonal effect on LM morphology varies with the particular hormone used. Certain HTs are more likely to be associated with increased degenerative and atypical changes.
©2012 Yale Department of Pathology. All rights reserved.
Any redistribution or reproduction of part or all of the contents in any form is prohibited. You may not, except with express written permission of the author or the Department of Pathology, distribute or commercially exploit the content, nor may you transmit it or store it in any other website or other form of electronic retrieval system, including use for educational purposes.