Endometrial granulomas with Levonorgestrel Intrauterine System (Mirena)

Charlton, Fletcher; Otton, Geoffrey; Hedges, Andrew H.; Scurry, James

doi:10.1097/pat.0000000000000127

Cited by 5 publications

(3 citation statements)

References 3 publications

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“…Furthermore, most forms of endometritis include a more significant mixed inflammatory cell infiltrate than seen in the cases described herein. The clinical context, namely the presence of a L-IUS, is clearly a helpful pointer towards ESM although it should be noted that endometrial granulomas may be seen in association with intrauterine devices (10,27,28).…”

Section: Discussionmentioning

confidence: 98%

“…Occasionally, there may be foci of infarction, stromal hyalinization including hyaline nodules, and calcification (6)(7)(8)(9). Recently Charlton et al (10) described a granulomatous reaction to amorphous eosinophilic material, possibly necrotic decidualized stroma. A small proportion of patients using any type of intrauterine device develop significant endometritis or pelvic inflammatory disease which may be associated with Actinomyces infection (11).…”

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confidence: 96%

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Endometrial Synovial-like Metaplasia Associated With Levonorgestrel-releasing Intrauterine System

Stewart

Leake

2015

International Journal of Gynecological Pathology

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The levonorgestrel-releasing intrauterine system (L-IUS) is widely used in contraception and in the treatment of menorrhagia, dysmenorrhea, adenomyosis, and endometriosis. L-IUS is also increasingly considered in the management of endometrial neoplasia and its precursors. Histologic changes in the endometrium can be due to the effects of high-dose progestogen or may be caused by the local irritant or mechanical effects of an intrauterine foreign body. In the present study, we describe a novel endometrial alteration associated with L-IUS that most closely resembles synovial metaplasia reported at other extra-articular anatomic sites. Eleven cases were identified with a mean age of 49.6 yr. In most patients L-IUS was used for management of menorrhagia or endometrial hyperplasia. Endometrial synovial-like metaplasia was always a focal finding and was associated with areas of surface epithelial erosion. The synovial-like cells showed a distinctive palisaded arrangement with orientation perpendicular to the endometrial surface. Multinucleate cells were present in 2 cases, but granulomas were not identified. The synovial-like cells were vimentin immunoreactive and a variable proportion of cells expressed CD68. Only focal CD10 staining was seen and there was no expression of estrogen receptor, progesterone receptor, or cytokeratin. In summary, L-IUS may be associated with a distinctive synovial-like metaplastic alteration which most likely represents a stromal reaction to an intrauterine foreign body following endometrial surface erosion. The synovial-like cells appear to comprise histiocytes and modified fibroblasts or stromal cells similar to this process in other sites.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 96%

Endometrial Synovial-like Metaplasia Associated With Levonorgestrel-releasing Intrauterine System

Stewart

Leake

2015

International Journal of Gynecological Pathology

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“…Analysing the physiopathological aspects of morphological alterations in the endometrium after LNG-IUS insertion, recent studies show that exposure to the levonorgestrel concentrations released by this kind of device would result in increased expression of tissue factor (TF), interleukin-8 (IL-8), interleukin-13 (IL-13) and interleukin-15 (IL-15), cyclooxygenase-2 and matrix metalloproteinases (MMPs). These markers could facilitate leukocyte infiltration, especially of natural killer cells specific for uterine endometrium, and epithelial degradation, with posterior formation of foci of necrosis and calcification 4,6,[7][8][9][10][11][12] . There would also be increased expression of vascular endothelial growth factor (VEGF), which would act as to increase vascular permeability, promoting aberrant angiogenesis and resulting in haemorrhages, microthromboses and ulceration of the epithelium 4,7,10,12 .…”

Section: Discussionmentioning

confidence: 99%

Morphological alterations in endometrium after use of levonorgestrel-releasing intrauterine system: a case report

et al. 2020

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Relato de Caso: Paciente de 44 anos compareceu ao serviço de ginecologia para consulta de rotina. Relatou implante de dispositivo intrauterino com liberação de levonorgestrel (DIU-LNG) há cinco anos. Durante o exame físico, o fio do dispositivo não foi visualizado. À histeroscopia, para remoção do dispositivo, não foram evidenciadas alterações na cavidade endometrial. Material foi, então, colhido para biópsia. O estudo histopatológico evidenciou um endométrio com estroma expandido por pseudodecidualização e alterações mucoides, formando pequenos aglomerados de mucina, também se apresentando com endentações polipoides, vasos ectásicos, focos de células linfoides e depósitos de sais de cálcio. A presença de DIU-LNG na cavidade uterina causa uma série de alterações histopatológicas e funcionais no endométrio, as quais não são relacionadas, exclusivamente, ao efeito contraceptivo do dispositivo. Conclusão: Com o aumento da utilização desse método anticoncepcional, o conhecimento das alterações provocadas pelo seu uso se torna cada vez mais relevante para avaliação de sua eficácia e segurança em longo prazo.

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