Leiomyoma with Isolated Foam Cell Vasculopathy: A Case Report

Abstract

Foam cell vasculopathy is an obliterating type of vasculitis characterized by fibrinoid necrosis, sub-intimal foam cell deposition, vessel wall hyalinosis, and lymphocytic infiltrate. Isolated intra-tumoral foam cell vasculitis is rare and similar changes have been reported in a leiomyoma attributed to treatment with tranexamic acid and gonadotropin-releasing hormone (GnRH) analogs. A 68-year-old hypertensive and diabetic female (P2L2) presented with vaginal spotting and vague abdominal pain. An ultrasound abdomen showed an anterior wall fibroid measuring 5 × 4 cm. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Microscopic sections from the leiomyoma showed multiple foci of obliterating vasculitis, along with fibrinoid necrosis, sub-intimal foam cell deposition, and hyalinosis. There was no involvement of the endometrium, cervix, or ovaries. There were no pulmonary, skin, or renal lesions, or history of systemic vasculitis, and treatment by tranexamic acid or GnRH analogs. This prompted a diagnosis of idiopathic intra-tumoral foam cell vasculitis. This finding has been documented previously in three instances, namely, within a renal angiomyolipoma, cerebral Hodgkin’s lymphoma, and a gastrointestinal stromal tumor; the present case provides the first-ever documentation of isolated intra-tumoral acute atherosis-like/foam cell vasculopathy in leiomyoma.

Keywords

• foam cell
• leiomyoma
• preeclampsia
• tranexamic acid
• vasculitis