Bilateral uterine artery embolization has recently been employed as an alternative to operational treatment of uterine leiomyomas. The pathologic features induced by uterine artery embolization have not been previously described in detail. Usually patients experience symptomatic improvement with a reduction in size of the leiomyomas. This report describes the pathologic features in a series of 10 uterine leiomyomas where tissue was available for histologic examination following uterine artery embolization. Characteristic histologic features within the leiomyomas included massive necrosis, sometimes with dystrophic calcification, vascular thrombosis, and intravascular foreign material that elicited a histiocytic and foreign-body giant cell reaction. In some cases, intravascular foreign material was present elsewhere in the myometrium, the cervix, or paraovarian region. In occasional cases, there were foci of myometrial necrosis and microabscess formation beyond the confines of the leiomyomas. Foci of extrauterine inflammation were also occasionally identified. Histopathologists should be aware of these findings because the use of uterine artery embolization will possibly become more widespread in the future.
Departments of Pathology (W.G.M.), Radiology (P.K.E.), and Obstetrics and Gynaecology (N.M.), Royal Group of Hospitals Trust, Belfast, Northern Ireland; Departments of Radiology (W.J.W.), and Pathology (P.A.J.), Royal Surrey County Hospital, Guildford, United Kingdom; and Department of Pathology (S.M.), Oxford Radcliffe Hospital, Oxford, United Kingdom.
Address correspondence reprint requests to Dr. W. G. McCluggage, Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BL, Northern Ireland.