Case Reports
Squamous Metaplasia of Endometrium after Uterine Artery Embolization for Symptomatic Leiomyomata

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Abstract

Uterine artery embolization (UAE) is frequently performed for symptomatic leiomyomata. There have been no reports of squamous metaplasia of endometrium after such a procedure. Squamous metaplasia of endometrium is often associated with endometrial hyperplasia and carcinoma. In our patient the disorder was diagnosed after UAE. This is the second such case we have encountered. In view of the association of squamous metaplasia with endometrial hyperplasia and carcinoma, a history of recent UAE must be considered in evaluating a patient with this finding, particularly on a biopsy specimen.

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Case Report

A 53-year-old woman underwent hysterectomy 3 months after UAE for symptomatic leiomyomata and received progestational therapy during the 3-month interval. Her history was significant for tubal ligation in 1977. She had massive bleeding, severe anemia, and an aborting submucous leiomyoma. Uterine artery embolization was performed with polyvinylalcohol particles suspended in iodine contrast material. It was a temporizing procedure, and although no fur- ther bleeding ensued, the large uterine size

Discussion

Squamous metaplasia of endometrium has been described in the presence of estrogen excess, progestins, vitamin deficiency, chronic endometritis, human papilloma virus, tuberculosis, syphilis, irradiation, foreign bodies including intrauterine devices and fibroblast-carrying Ivalon sponges, submucous leiomyomata, and pyometra.4, 5, 6, 7, 8, 9, 10 It is often associated with endometrial hyperplasia, and when it is present in extensive amounts on a biopsy specimen, carcinoma should be ruled out. To

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    Citation Excerpt :

    Joyce et al. (8) described a leiomyosarcoma diagnosed in a postembolization surgical intervention in a patient who remained symptomatic. Hameed et al. (9) have described two cases of squamous metaplasia of the endometrium after uterine artery embolization. These data suggest that careful study of the uterine cavity and endometrium is required after embolization, because these alterations are related to hyperplasia and adenocarcinoma of the endometrium.

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