PATHOLOGICAL-CHANGES IN GONADOTROPIN-RELEASING-HORMONE AGONIST ANALOGTREATED UTERINE LEIOMYOMATA

Objective: To define the pathologic changes underlying the mechanism o f shrinkage of uterine leiomyomata in patients treated with luprolide acetate. Design: Retrospective study of pathologic changes seen in lei omyomata removed by hysterectomy or myomectomy in treated and untreate d patients, matched by age and size of uteri and leiomyomata. Patient( s): Gross description and histologic slides of 30 treated and 30 untre ated patients. Intervention(s): Histologic examination performed blind ly (without knowledge of treatment). Statistical work-up using chi(2) analysis with 1 df. Main Outcome Measure(s): Degree of hyaline and hyd ropic degeneration, cellularity, nuclear atypia, necrosis, and obliter ation of interface. Result(s): Confluent nodular hyaline degeneration representing a scarlike retraction, geographic hydropic degeneration n ecrosis and obliteration of the interface between myoma and myometrium were found in higher proportions in the treated patients; differences in cellularity, nuclear atypia, and edema were not statistically sign ificant. Conclusion(s): The decrease in size of the treated leiomyomat a occurs as an accelerated postmenopausal shrinkage because of the ant iestrogenic effect of the therapy. Obliterated cleavage planes may exp lain the difficult enucleation of myomatous nodules in some of the tre ated patients. (C) 1997 by American Society for Reproductive Medicine.