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Apoplectic leiomyomas: does ethnicity make a difference? a clinicopathologic study

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Abstract

Apoplectic leiomyomas—benign uterine leiomyomas with morphologic changes including hemorrhage, hypercellularity, mitotic activity, nuclear atypia, and even necrosis—can be difficult to distinguish from uterine leiomyosarcomas. Apoplectic leiomyomas have been associated with hormonal therapy; however, the relationship between apoplectic leiomyomas, hormones, and ethnicity has not received much attention in the literature. We evaluated the relationship of hormonal therapy and ethnicity in 869 women with uterine leiomyomas, 136 of which qualified as apoplectic leiomyomas.

Apoplectic leiomyomas were observed in 23.3% (49/210) of women exposed to hormonal therapy compared to 13.2% (87/659) of women not exposed to hormonal therapy (p < 0.0001). Women taking ethinyl estradiol/norethindrone (Lo-Estrin), leuprolide, and medroxyprogesterone were significantly more likely to have apoplectic leiomyomas compared to women taking other hormonal therapies. Apoplectic leiomyomas were observed in 28.9% (44/152) of African-American women compared to 12.4% (79/639) of Caucasian women (p < 0.0001), and this difference remained statistically significant regardless of hormone use. Apoplectic leiomyomas were observed in 22.1% (77/349) of women ≤ 45 years of age compared to 11.3% (59/520) of women > 45 years of age (p < 0.0001), and this difference remained statistically significant regardless of hormone use.This is the largest study to date examining apoplectic leiomyomas in women on known hormonal therapy compared to women with uterine leiomyomas, but not on hormonal therapy. Information about hormonal therapy, ethnicity, and age can be helpful in the diagnostic interpretation of apoplectic leiomyoma.

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14620, USA

    Bradley M. Turner

  2. Rochester General Hospital, 1425 Portland Ave, Rochester, NY, 14621, USA

    Stewart F. Cramer

  3. Departments of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, 185 South Orange Ave, UH E158, Newark, NJ, 07103, USA

    Debra S. Heller

  4. Department of Pathology, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA

    Fattaneh A. Tavassoli

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  2. Stewart F. Cramer
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  4. Fattaneh A. Tavassoli
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Contributions

Dr. Turner helped to conceive the study. Dr. Turner designed the study, drafted, and finalized the manuscript. Dr. Cramer critically revised and finalized the manuscript. Dr. Heller critically revised and finalized the manuscript. Dr. Tavassoli helped to conceive the study. Dr. Tavassoli critically revised and finalized the manuscript. All authors approved the submitted version.

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Correspondence to Bradley M. Turner.

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This paper represents a retrospective evaluation of benign de-identified tissue. Approval by the ethics committee and/or informed consent is not required.

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Dr. Turner declares that he has no conflicts of interest to declare that are relevant to the content of this article. Dr. Cramer declares that he has no conflicts of interest to declare that are relevant to the content of this article. Dr. Heller declares that she has no conflicts of interest to declare that are relevant to the content of this article. Dr. Tavassoli declares that she has no conflicts of interest to declare that are relevant to the content of this article.

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Turner, B.M., Cramer, S.F., Heller, D.S. et al. Apoplectic leiomyomas: does ethnicity make a difference? a clinicopathologic study. Virchows Arch 480, 645–654 (2022). https://doi.org/10.1007/s00428-021-03225-z

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