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Case Reports and Images in Obstetrics and Gynecology

 
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Case Report
 
Repeated intermittent use of ulipristal acetate associated with rapid growth and multilocular cystic hydropic degeneration of a uterine fibroid: A case report
Synnöve Maaria Staff1,2, Sami Kristian Saarelainen1, Marita Aino Laurila3
1MD, PhD, Consultant, Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
2Postdoctoral fellow, Laboratory of Cancer Biology, Institute of Biomedical Technology, BioMediTech, University of Tampere, Tampere, Finland.
3MD, Consultant pathologist, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland.

Article ID: 100014Z08SS2016
doi:10.5348/Z08-2016-14-CR-7

Address correspondence to:
Synnöve Maaria Staff
Department of Obstetrics and Gynecology
Tampere University Hospital, Teiskontie 35, PL2000
33521 Tampere
Finland

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How to cite this article:
Staff SM, Saarelainen SK, Laurila MA. Repeated intermittent use of ulipristal acetate associated with rapid growth and multilocular cystic hydropic degeneration of a uterine fibroid: A case report. J Case Rep Images Gynecol Obstet 2016;2:31–34.


Abstract
Introduction: Uterine fibroids or leiomyomas are common benign tumors often associated with menorrhagia, pressure symptoms and dysmenorrhea. Selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA) have been proven a safe and effective treatment resulting in significant volume reduction of uterine fibroids and amenorrhea. Safety concerns of long-term use of UPA have mainly focused on endometrial changes, which have been proven to be benign and self-resolving.
Case Report: A 44-year-old woman presented with symptomatic subserosal fibroid of 7.5 cm in diameter and was prescribed UPA for three months. After a positive initial treatment response, a repeated three-month course of UPA was started. At the end of the second course the patient became symptomatic presenting with cyclic abdominal pain. Ultrasound imaging revealed a large multilocular cystic pelvic mass sized 10x11 cm suspicious of a malignant tumor and abdominal hysterectomy was performed. The uterine specimen weighed 1066 g and consisted mainly of a large multicystic tumor, which was confirmed a benign fibroid with cystic hydropic degeneration by histopathological analysis.
Conclusion: Ulipristal acetate treatment has been suggested to inhibit fibroid growth partly by down-regulation of local angiogenic factors, which is the hypothetical pathogenetic mechanism for cystic degenerative tumor growth in the present case. It is important to bring about awareness to clinicians about this SPRM-induced benign condition in order to avoid misdiagnosis of a malignant process.

Keywords: Cystic degeneration, Selective progesterone-receptor modulator (SPRM), Ulipristal acetate, Uterine fibroid


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Author Contributions
Synnöve Maaria Staff – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sami Kristian Saarelainen – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Marita Aino Laurila – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published.
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Synnöve Maaria Staff et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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