Cotter Thomas, Arfa Ahmed, Moideen Pramila, Ullah Asad, Ghleilib Intisar
Pathology, Augusta University Medical College of Georgia, Augusta, USA.
Pathology and Laboratory Medicine, Augusta University Medical College of Georgia, Augusta, USA.
Cureus. 2022 Mar 30;14(3):e23646. doi: 10.7759/cureus.23646. eCollection 2022 Mar.
An arteriovenous malformation (AVM) is a vascular lesion most frequently encountered in the brain, lungs, colon, and soft tissues of the extremities. However, rarely, an AVM may develop in the uterus, where it can cause abnormal and even life-threatening uterine bleeding. Here, we present the case of a 41-year-old G6P6 woman with abnormal uterine bleeding which resulted in a hemoglobin level of 10.2 g/dL. On gross examination, the uterus was enlarged measuring 17.5 cm x 12.0 cm x 10.0 cm, with a pronounced globoid appearance and bogginess on palpation. The cut surface was hemorrhagic and notable for numerous tortuous dilated spaces of variable sizes. These hemorrhagic, cavernous spaces were grossly apparent throughout the entire myometrium, but were found to be most prominent in the lower uterine segment of the anterior wall. Microscopic examination revealed an admixture of malformed vasculature comprising arteries, venules, and capillaries. The vessels showed prominent dilation and tortuosity with abrupt variation in the thickness of the media and elastic lamina, as highlighted by Von Gieson stain. Unlike in many other organ systems where AVMs are often considered congenital lesions, uterine AVMs are more often acquired lesions that develop following iatrogenic uterine trauma, namely cesarean section or curettage. Upon review of our patient's history, her final delivery was via cesarean section, after which she developed abnormal uterine bleeding. We present this case as a reminder to consider uterine AVM in cases of abnormal uterine bleeding, as it may be easily overlooked by even the most experienced pathologist.
动静脉畸形（AVM）是一种血管病变，最常见于脑、肺、结肠和四肢软组织。然而，AVM很少发生在子宫，在子宫中可导致异常甚至危及生命的子宫出血。在此，我们报告一例41岁、孕6产6的女性，因子宫异常出血导致血红蛋白水平为10.2 g/dL。大体检查时，子宫增大，大小为17.5 cm×12.0 cm×10.0 cm，外观呈明显的球形，触诊时有饱满感。切面呈出血性，可见许多大小不一的迂曲扩张间隙。这些出血性海绵状间隙在整个肌层均明显可见，但在前壁子宫下段最为突出。显微镜检查显示，畸形血管由动脉、小静脉和毛细血管混合组成。血管显示出明显的扩张和迂曲，中膜和弹性膜厚度突然变化，经冯·吉森染色突出显示。与许多其他器官系统中AVM常被认为是先天性病变不同，子宫AVM更常是医源性子宫创伤（即剖宫产或刮宫）后发生的后天性病变。回顾我们患者的病史，她最后一次分娩是剖宫产，之后出现了子宫异常出血。我们报告此病例是为提醒在子宫异常出血病例中考虑子宫AVM，因为即使是最有经验的病理学家也可能容易忽视它。
