Although adenomyosis is known to increase the risk of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), association of disseminated intravascular coagulation (DIC) is rare. We report two patients with adenomyosis presenting with PTE, in whom DIC was noted by massive vaginal bleeding. Case 1 : a 42-year-old woman with adenomyosis complained of excessive vaginal bleeding and lower abdominal pain on the second day of menstruation. A blood sample showed a low platelet count (Plt, 68,000/μl),elevated FDP-D dimer (FDP-DD, 125.5μg/ml) and low fibrinogen (Fib, 83.2mg/dl), indicating DIC. Case 2 : a 49-year-old woman with adenomyosis was suffering from massive vaginal bleeding after estrogen-progestin therapy for hypermenorrhea. DIC was noted by low Plt (117,000/μl), elevated FDP-DD (314.6μg/ml) and low Fib (69.2mg/dl). Their DIC and massive bleeding improved with coagulation factor replacement for DIC. Case 1 underwent hysterectomy 22 days after the diagnosis of DIC. Case 2 underwent hysterectomy when the disappearance of PTE was confirmed after 5 months of gonadotropin-releasing hormone agonist and anti-coagulation therapy. These two cases suggest that an adenomyosis-induced hyper-coagulation status as indicated by PTE, and vaginal bleeding may trigger DIC due to the consumption of coagulation factors. Great care should therefore be paid to thrombosis as well as DIC in patients with adenomyosis.
A 75-year-old woman with Hashimoto's disease diagnosed 11 years previously was found to have a nodule in the anterior cervix. Ultrasonography showed a low echoic mass 5×4×3cm in diameter in the left lobe of the thyroid gland. Aspiration biopsy cytology (ABC) of the tumor indicated the possibility of lymphoma. Surgical resection of the left lobe of the thyroid gland was performed in order to obtain histopathological diagnosis. The thyroid tumor was diagnosed as a diffuse large B-cell lymphoma (DLBCL) with follicular lymphoma. Whole body CT and 67Ga-scintigraphy showed no abnormal findings in other organs, and the tumor stage was IE. After surgery, three courses of R-CHOP immunochemotherapy followed by radiotherapy to the neck were performed. There has been no sign of tumor recurrence in the 19 months since the operation. As seen in the present case, lymphoma should be considered in the differential diagnosis when a growing nodule appears in the anterior cervix in middle-aged and elderly women with Hashimoto's disease. Although, in the present case, the DLBCL was smaller than the follicular lymphoma within the tumor, the presence of DLBCL is important for the treatment of thyroid lymphoma. Because it is difficult to diagnose thyroid lymphoma precisely using ABC, surgery also plays an important role in obtaining a histopathologic diagnosis for multidisciplinary treatment.
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