THROMBOSIS, LEIOMYOMA AND GNRH-A THERAPY - A CASE-REPORT

BACKGROUND: Diverse complications have been reported in association wi th the growth and medical treatment of uterine leiomyomata. Infarction and necrosis may be common and incite complications from parasitic va scular attachment, pain and thrombosis. The rarity of severe complicat ions in this situation warrants presentation of the following unique a ssociation. CASE: A 33-year-old female, gravida 1, para 1, was treated with gonadotropin-releasing hormone agonist (GnRH-a) for three months prior to laparotomy and removal of a solitary, 5,190-g, pedunculated myoma. The mass had secured an additional vascular supply fi om the tr ansverse colon and omentum. Although the immediate postoperative cours e was uncomplicated, delayed onset of abdominal pain and fever lead to the diagnosis of superior mesenteric and portal vein thrombosis. Port al vein thrombosis responded to thrombolytic infusion into the superio r mesenteric artery. Superior mesenteric vein thrombosis persisted, wi th evidence of early vascular recanalization. After six weeks of addit ional anticoagulation, assessment by computed tomographic scan showed complete resolution of all thrombi. CONCLUSION: While thrombosis has b een reported with GnRH-a therapy in men with prostate cancer, its asso ciation with treatment in this benign case may have been a consequence of the massive tumor size. Steroid hormone deprivation potentially co ntributed to neovascularization and bowel involvement.