Document Type : Case Reports

Authors

1 Department of Pathology, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India

2 Department of Obstetrics and Gynaecology Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India

Abstract

Uterine leiomyoma with hepatic vasculopathy, specifically non-cirrhotic portal fibrosis (NCPF), has hitherto been undescribed. NCPF is characterized by elevated portal pressure sans cirrhosis and has previously not been described in association with a gynecological pathology. We report the case of a female under evaluation for a heterogeneously enhancing intrauterine mass with multiple hepatic lesions with increased uptake of fluorodeoxyglucose on positron emission analysis. Fibroscan values were increased. Histopathologic evaluations revealed a leiomyoma with liver tissue showing tubercular granulomas, thin wispy fibrotic strands, and rounded portal tracts pointed to NCPF. No evidence of malignancy was seen. Metabolic imaging may be unreliable to distinguish between benign and malignant uterine pathology and granulomatous and malignant hepatic lesions. Elastography may also be ineffective in diagnosing the etiology of liver fibrosis. Histopathological analysis hence remains essential despite noninvasive tests. Further research is required on females afflicted with NCPF to exclude a hormonal link.

Highlights

  • Possibility of a hormonal link between uterine leiomyoma and non-cirrhotic portal fibrosis
  • Fluorodeoxyglucose Positron emission analysis may be falsely positive in benign conditions
  • Histopathological analysis remains paramount despite the dawn of a noninvasive and serological era

Keywords

Main Subjects

  1. Williams AR. Uterine fibroids–what’s new?. F1000Research. 2017;6. [DOI:10.12688/f1000research.12172.1] [PMID] [PMCID]
  2. Sarin SK, Philips CA, Khanna R. Noncirrhotic portal hypertension: medical and endoscopic management. Clin Liver Dis. 2015;6(5):107. [DOI:10.1002/cld.511] [PMID] [PMCID]
  3. Borahay MA, Asoglu MR, Mas A, Adam S, Kilic GS, Al-Hendy A. Estrogen receptors and signaling in fibroids: role in pathobiology and therapeutic implications. Reprod Sci. 2017;24(9):1235-44. [DOI:10.1177/1933719116678686] [PMID] [PMCID]
  4. Chawla CD, Chaudhary MS, Joneja GS, Bugga A. Fibroid uterus an unusual presentation: a case report. Med J Armed Forces India 1995 ; 51(3):218-19. [DOI:10.1016/S0377-1237(17)30971-1]
  5. Marks WH, Thompson N, Appleman H. Failure of hepatic adenomas (HCA) to regress after discontinuance of oral contraceptives. An association with focal nodular hyperplasia (FNH) and uterine leiomyoma. Ann Surg 1988; 208(2):190-95. [DOI:10.1097/00000658-198808000-00010] [PMID] [PMCID]
  6. Porter LE, Elm MS, Van Thiel DH, Eagon PK. Hepatic estrogen receptor in human liver disease. Gastroenterology 1987; 92(3):735-45. [DOI:10.1016/0016-5085(87)90026-6]
  7. Gaur K, Ali S, Sakhuja P, Majumdar K, Agarwal A, Puri A. Is non cirrhotic portal fibrosis actually cirrhosis in regression? A histopathological study of the "Hepatic repair complex" in Indian patients. J Clin Exp Hepatol 2016; 6:S97. [DOI:10.1016/j.jceh.2016.06.163]
  8. Meena M, Dixit R, Meena LP, Samaria JK. Primary/local hepatic tuberculosis without dissemination. BMJ Case Rep 2015; 2015: bcr2014206974. [DOI:10.1136/bcr-2014-206974] [PMID] [PMCID]
  9. Heysell SK, Thomas TA, Sifri CD, Rehm PK, Houpt ER. 18-Fluorodeoxyglucose positron emission tomography for tuberculosis diagnosis and management: a case series. BMC Pulm Med 2013; 13:14. [DOI:10.1186/1471-2466-13-14] [PMID] [PMCID]
  10. Choi JY, Jhun BW, Hyun SH, Chung MJ, Koh WJ. 18 FDG positron emission tomography/ computed tomography for assessing treatment of pulmonary multidrug resistant tuberculosis . J Clin Med 2018; 7(12):599. [DOI:10.3390/jcm7120559] [PMID] [PMCID]
  11. Nishizawa S, Inubushi M, Kido A, et al. Incidence and characteristics of uterine leiomyomas with FDG uptake. Ann Nucl Med 2008; 22(9):803-10. [DOI:10.1007/s12149-008-0184-6] [PMID]
  12. Yasuda M , Shimizu I, Shiba M, Ito S. Suppressive effects of estradiol on dimethylnitrosamine-induced fibrosis of the liver in rats. Hepatology 1999; 29(3):719-27. [DOI:10.1002/hep.510290307] [PMID]
  13. Khanna R, Sarin SK. Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatol Int 2018 ;12(1):148-67. [DOI:10.1007/s12072-018-9844-3] [PMID]