Pathologic features of uterine leiomyomas following uterine artery embolization

Bilateral uterine artery embolization has recently been employed as an alte rnative to operational treatment of uterine leiomyomas. The pathologic feat ures induced by uterine artery embolization have not been previously descri bed in detail. Usually patients experience symptomatic improvement with a r eduction in size of the leiomyomas. This report describes the pathologic fe atures in a series of 10 uterine leiomyomas where tissue was available for histologic examination following uterine artery embolization. Characteristi c histologic features within the leiomyomas included massive necrosis, some times with dystrophic calcification, vascular thrombosis, and intravascular foreign material that elicited a histiocytic and foreign-body giant cell r eaction. In some cases, intravascular foreign material was present elsewher e in the myometrium, the cervix, or paraovarian region. In occasional cases , there were foci of myometrial necrosis and microabscess formation beyond the confines of the leiomyomas. Foci of extrauterine inflammation were also occasionally identified. Histopathologists should be aware of these findin gs because the use of uterine artery embolization will possibly become more widespread in the future.