Does Hormonal Therapy Affect the Morphology of Uterine Smooth Muscle Tumors?
Bradley M Turner, Fattaneh A Tavassoli. Yale School of Medicine, New Haven, CT
Background: The reported histopathologic findings in leiomyomas (LM) among women treated with hormones vary. Degenerative (necrosis/infarction, myxedema) and/or atypical (cytologic atypia, increased mitotic activity) changes have been observed in uterine smooth muscle tumors in association with oral contraceptive (OC) use. We compared LM with and without degenerative and/or atypical changes to assess the association of hormonal therapy with these morphologic features.
Design: We searched the pathology database at the Yale School of Medicine between 1/1/2005 and 9/1/2011. 1815 female patients with a diagnosis of LM were identified. Cases associated with concurrent cancer, pregnancy or previous uterine artery embolization were excluded. The medical records for the remaining patients' were examined for documentation of any prior hormonal therapy, along with its duration and dosage when available.
Results: 875 cases (733 hysterectomies,142 myomectomies) were eligible for the study (age range [19-95 years]; median [47 years]). 210 (24%) patients were on homonal therapy within 3 months of surgery, 48 with degenerative changes and 162 without degenerative changes. Hormonal therapies included progesterone/estrogen OC (102), progesterone (17), estrogen (29), leuprolide (45) and Tamoxifen (17). Prior hormonal therapy was significantly associated with degenerative (Table 1,2; p=0.002, Fishers exact [FE]), but not atypical changes (p=0.164, FE). Significant associations were attributable only to leuprolide (p=0.0001, FE), Loestrin (p=0.007, FE), and medroxyprogesterone (p=0.034, FE).
Conclusions: Hormonal effect on LM morphology varies with the particular hormone used. Certain OC are more likely to be significantly associated with increased degenerative changes, including necrosis/infarction and myxedema. Hormonal therapy did not appear to be significantly associated with increased cytologic atypia or increased mitotic activity in LM in this group of cases.
|Degenerative features?||Any hormone||Progesterone||Norethindrone||Estrogen||Leuprolide||Tamoxifen|
|Yes # (%)||48(100)||0 (0)||1 (2)||1 (2)||19 (40)||1 (2)|
|No # (%)||162(100)||4 (2.5)||12 (7)||28 (17)||26 (16)||16 (10)|
|Degenerative features?||Unidentified OC||Loestrin||Norgestrel||Medroxyprogesterone||Levoenorgestrel||Other*|
|Yes # (%)||11 (23)||5 (10)||1 (2)||7 (15)||2 (4)||0 (0)|
|No # (%)||37 (23)||4 (2.5)||3 (2)||14 (9)||3 (2)||15 (9)|