Significance of Gynecologic Vasculitis.
Andres A Roma, Catalina Amador-Ortiz, Helen Liapis. Cleveland Clinic, OH; Washington University in St. Louis, MO
Background: Vasculitis includes a heterogeneous group of disorders with the common histologic findings of vascular wall inflammation. Systemic or localized disease (e.g., renal vasculitis) has serious consequences. The incidence of gynecologic vasculitis (GynV) and its significance is little known.
Design: We performed a retrospective review of vasculitis cases affecting the female genital tract accessioned in our institution between 1990- 2010. Fifty-two cases were identified. Histopathologic evaluation, clinicopathologic review and follow-up was performed.
Results: Age of the patients ranged from 37 to 85 years (mean 55.2 years, median 51 years). None had prior symptoms or were diagnosed with generalized vasculitis, while one patient had prior diagnosis of fibromyalgia. Most patients presented with abnormal bleeding and were treated for conditions unrelated to vasculitis, including patients with hysterectomy for uterine tumors (n=34); ovarian tumors (n=15), cervical dysplasia (n=2), uterine prolapse (n=1), cesarean section complications (n=1), and unknown reasons (n=1). All patients had hysterectomy while 5 in addition had unilateral salpingo-oophorectomy and 37 had bilateral salpingo-oophorectomy. Vasculitis was confined to the cervix in 23 cases, endo-myometrium in 6 cases, ovaries 7 cases, fallopian tubes 3 cases, adnexal soft tissue 3 cases and diffuse (vasculitis involving more than one organ) 10 cases. The different types of vasculitis were: necrotizing 16 cases, predominantly lymphocytic 14 cases, granulomatous 5 cases, and non-specific in the remaining 17 cases. Only 2 patients had serologic tests: ESR, ANA, Anti-double stranded DNA and Anti-centromere. Only the patient with fibromyalgia was ANA +, but negative for the remaining tests. None of the patients with GynV received corticosteroids or additional treatment. Fourteen patients were lost to follow-up less than 1 month after surgery. Follow-up available for the remaining patients ranged from 2 month to 19.5 years (mean, 5.5 years). Seventeen patients had malignant tumors; two died of disease. During follow-up, two patients developed invasive ductal carcinoma (breast), one patient developed MGUS, and another was diagnosed with Hashimoto disease and ulcerative colitis. None of the patients developed systemic vasculitis.
Conclusions: GynV is rarely associated with systemic vasculitis. Potential GynV causes include: previous surgical interventions and vascular inflammation secondary to local malignancy. In the absence of symptoms of systemic vasculitis, serologic screening and systemic therapy is not required.
Category: Gynecologic & Obstetrics
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 133, Tuesday Afternoon