SESSION TYPE: Cancer Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Angioleiomyoma is an unusual type of benign tumor originating from mesenchymal tissue. We present the rare case of consumptive coagulopathy secondary to a large degenerated uterine angioleiomyoma.
CASE PRESENTATION: A 38-year-old woman presented to her physician four months prior complaining of an enlarging abdomen. An outpatient computed tomography (CT) scan demonstrated a large 25 × 28 × 25 cm abdominal mass with central areas of necrosis. On admission, four months after her initial physician visit, the patient presented to the hospital with complaints of excessive menstrual vaginal bleeding with dime-sized clots and abdominal cramping pain for the previous five days. Physical examination revealed a large non-tender abdominopelvic mass estimated to be equivalent in size to a 40-weeks’ gestation. Coagulation studies upon admission were consistent with consumptive coagulopathy. This was evidenced by the following: platelet count 69 × 103/mm3, INR > 7.9, fibrinogen <40 mg/dL, D-dimer >5250 units. Hemoglobin was 6.3 g/dL Red cell morphology demonstrated anisocytosis, poikilocytosis, and schistocytes. CT scan of the abdomen and pelvis with contrast demonstrated a necrotic mass arising out of the pelvis measuring 29.2 × 28.6 × 30 cm, an enlargement from the previous scan four months prior. Two days after admission, the patient was taken for laparotomy. The tumor was completely removed with total abdominal hysterectomy and bilateral salpingo-oophorectomy. The patient refused fresh frozen plasma, citing religious reasons, as the patient is a Jehovah’s Witness. She accepted 10 units of cryoprecipitate. On gross examination, the uterus and cervix weighed 9300 g and measured 28 × 27.5 × 17 cm. The myometrium showed several, gray-white, rubbery masses with whorled surfaces. Based on these findings, a pathologic diagnosis of angioleiomyoma was made. One day after surgery, the patient’s coagulation profile revealed Hb 6.8 g/dL with a slightly higher platelet count of 72 × 103/mm3, INR 1.3. Postoperative recovery was uneventful and the patient was released from the hospital six days later.
DISCUSSION: It is well documented that malignant tumors frequently cause hemostatic abnormalities. Approximately 10-15% of metastatic tumors are known to cause consumptive coagulopathy. Angioleiomyoma is an unusual benign smooth muscle tissue tumor, commonly found in the head, neck and lower extremities. Very few cases of these tumors have been described at sites other than these locations. Our case presents the atypical occurrence of a large angioleiomyoma of the uterus activating consumptive coagulopathy.
CONCLUSIONS: The mainstay of treatment for angioleiomyoma is surgical removal. Surgical removal of the angioleiomyoma subsequently corrected the patient’s consumptive coagulopathy.
1) Hakverdi S, Dolapcioglu K, Gungoren A, Yaldiz M, Hakverdi AU. Multiple uterine angioleiomyomas mimicking an ovarian neoplasm: a case report. Eur J Gynaecol Oncol 2009;30(5):592-4.
DISCLOSURE: The following authors have nothing to disclose: Marci Handler, Fariborz Rezai, Kristin Fless, Mikhail Litinski, Paul Yodice
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