Pulmonary densities following a hysterectomy, caused by benign metastatic leiomyoma

A 49-year-old woman, who had undergone a hysterectomy 17 years previously, was referred with thoracic pain located on the right side that had been present for several weeks. Thoracic imaging showed multiple pulmonary lesions on both sides. Histological investigation of a biopsy from one of these lesions revealed a benign metastatic leiomyoma. The patient was treated with gonadotropin-releasing hormone (GnRH) analogue. The lesions showed regression and the symptoms disappeared. Benign metastatic leiomyoma is a rare benign clinical entity in women of fertile age who have had a surgical intervention on the uterus because of uterus myomatosus. The therapeutic options are surgical resection, removal of the hormonal stimulus by administering progesterone or GnRH-analogues or bilateral ovariectomy.</p

Pulmonale verdichtingen na een uterusextirpatie, door benigne metastatisch leiomyoom

A 49-year-old woman, who had undergone a hysterectomy 17 years previously, was referred with thoracic pain located on the right side that had been present for several weeks. Thoracic imaging showed multiple pulmonary lesions on both sides. Histological investigation of a biopsy from one of these lesions revealed a benign metastatic leiomyoma. The patient was treated with gonadotropin-releasing hormone (GnRH) analogue. The lesions showed regression and the symptoms disappeared. Benign metastatic leiomyoma is a rare benign clinical entity in women of fertile age who have had a surgical intervention on the uterus because of uterus myomatosus. The therapeutic options are surgical resection, removal of the hormonal stimulus by administering progesterone or GnRH-analogues or bilateral ovariectomy

No increased systemic fibrinolysis in women with heavy menstrual bleeding

BackgroundBleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of heavy menstrual bleeding. ObjectiveTo investigate fibrinolytic parameters, including clot lysis time, in women with heavy menstrual bleeding. MethodsWe included 102 patients referred for heavy menstrual bleeding (Pictorial Bleeding Assessment Chart score of >100) in our cohort. Patients and controls (28 healthy volunteers without heavy menstrual bleeding) underwent hemostatic testing in the first week after menstruation. For 79 patients and all controls, fibrinolytic parameters (thrombin-activatable fibrinolysis inhibitor activity, and plasminogen activator inhibitor-1, tissue-type plasminogen activator and plasmin inhibitor levels) and clot lysis time were available. ResultsFibrinolytic parameters were similar between patients and controls, except for thrombin-activatable fibrinolysis inhibitor (89.4% vs. 82.5%) and plasmin inhibitor (106% vs. 96%), the levels of which which were significantly higher in patients. In women with menorrhagia without gynecologic abnormalities, we found lower thrombin-activatable fibrinolysis inhibitor and plasminogen activator inhibitor-1 levels than in women with gynecologic abnormalities (thrombin-activatable fibrinolysis inhibitor, 85.4% vs. 94.8%; plasminogen activator inhibitor-1, 16.0gL(-1) vs. 24.5gL(-1)). ConclusionSystemic fibrinolytic capacity is not increased in women with heavy menstrual bleeding. Overall, levels of the fibrinolytic inhibitors thrombin-activatable fibrinolysis inhibitor and plasmin inhibitor were even higher in patients than in controls. However, in a subgroup of women without gynecologic abnormalities, relatively lower levels of inhibitors may contribute to the heavy menstrual bleeding