Arteriovenous malformations (AVM) of the corpus uteri

Abstract

Introduction: The arteriovenous malformations (AVM) are sporadic lesions and they consist in a large number of tortuous, dilated, and thick-walled vessels with different sizes. AVM can be divided into two distinct types, in relation to their site: the superficial type and the deep type. Uterine AVM are precisely labelable as deep AVM and they are well-known in the gynaecological and radiological practice, but rarely reported in the histopathological literature. Materials And Methods: To fill this gap, the authors have retrospectively examined 25 cases of incidental uterine AVM from post-menopausal Caucasian women with a mean age of 68 years (range 63 and 74 years), who underwent hysterectomy with bilateral salpingo-oophorectomy for uterine prolapse. Surprisingly, in the anamnestic records, all the patients suffered from dysmenorrhea during their life. Moreover, they have reviewed about 300 cases of uterine AVM, reported in the gynaecological and radiological English literature, correlating them with their observations. Results: From their results, it emerged that the use of the term 'acquired' to describe uterine AVM should be avoided, because all the present lesions show a malformative morphology, related to a developmental disorder. Since no criteria exist to differentiate between AVM and placental bed sub-involution, a descriptive nomenclature should be preferred in the radiologic terminology. Conclusion: AVM should be routinely remarked in the histopathological reports, because their presence could be correlated with an explainable history of dysmenorrhea. Even if embolization remains an acceptable form of treatment in order to avoid hysterectomy in those patients presenting with heavy life-threatening bleeding, a vasoconstrictive therapy could be considered when other possible causes of disabling dysmenorrhea are excluded and the presence of AVM at high flow has been ascertained by eco-colour Doppler.