Case of adenomyosis causing the activation of the coagulation system after a complete loss of endometrium following microwave endometrial ablation

Abstract

The formation of microbleed and minute tissue necrosis inside adenomyosis after the shedding of endometrial or endometrial-like tissue within the myometrium during menstruation is receiving attention as a new pathological condition of uterine adenomyosis. These formations might greatly affect coagulation and fibrinolysis function. However, these modulations might occur due to indirect effects of massive hemorrhage from the uterus with adenomyosis. We present a case of adenomyosis in which the patient's coagulation system was markedly activated despite the absence of menstruation due to previous microwave endometrial ablation to prevent massive uterine hemorrhage. Although no uterine bleeding was observed at all, the patient's serum levels of thrombinantithrombin complex and soluble fibrin were abnormally elevated at the time when she complained of lower abdominal pain. As the first such case in the world, the present case is valuable for showing that the coagulation function can be modified by uterine adenomyosis.

Possible association between adenomyosis and disseminated intravascular coagulation and thromboembolism: A systematic review

“…This indicates that the coagulation system is closely involved in the pathophysiology of established adenomyosis. As evidence, patients with adenomyosis during menstruation may have laboratory abnormalities associated with hypercoagulability and excessive hyperfibrinolysis (10,23). Elevated TAT, SF, D-dimer and PIC levels in patients with adenomyosis reflect a hypercoagulable and hyperfibrinolytic condition (10,23).…”

“…Some patients with adenomyosis with a history of cerebral infarction or pulmonary thromboembolism have been shown to have elevated levels of plasma TAT, SF, D-dimer and PIC, suggesting an increased predisposition to thromboembolic events (10). Kimura et al (23) also presented a rare case of adenomyosis causing the activation of the coagulation system following a complete loss of the endometrium following microwave endometrial ablation. The authors of that study suggested that the formation of microhemorrhage within adenomyotic lesions ws associated with elevated serum levels of the TAT complex and SF, reflecting a hypercoagulable state (23).…”

“…Kimura et al (23) also presented a rare case of adenomyosis causing the activation of the coagulation system following a complete loss of the endometrium following microwave endometrial ablation. The authors of that study suggested that the formation of microhemorrhage within adenomyotic lesions ws associated with elevated serum levels of the TAT complex and SF, reflecting a hypercoagulable state (23). Yamashiro et al (24) reported four cases of middle-aged women with adenomyosis with concomitant acute cerebral infarction.…”

“…The number of reported cases is limited (24); however, adenomyosis causes serious thromboembolism, including multiple cerebral infarctions. Diffuse adenomyosis, elevated levels of mucinous tumor markers, CA125 and CA19-9, and coexistence of NBTE may be at increased risk of developing thromboembolism (23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

“…As evidence, patients with adenomyosis during menstruation may have laboratory abnormalities associated with hypercoagulability and excessive hyperfibrinolysis (10,23). Elevated TAT, SF, D-dimer and PIC levels in patients with adenomyosis reflect a hypercoagulable and hyperfibrinolytic condition (10,23). In addition, patients with adenomyosis had prolonged activated partial thromboplastin time and a shortened thrombin time than those with uterine fibroids, indicating that adenomyosis affects the hemostatic system (19).…”