Recurrent Cerebral Infarcts Associated with Uterine Adenomyosis: Successful Prevention by Surgical Removal

Abstract

Hypercoagulability associated with malignant tumors causes thrombosis, termed Trousseau's syndrome, but is rarely associated with benign gynecological tumors, such as myoma and adenomyosis. We herein report a 47-year-old Japanese woman with uterine adenomyosis who developed multiple cerebral infarcts during menstruation. Edoxaban was initially used for prevention but failed to prevent recurrence of thrombosis. However, hysterectomy and bilateral salpingo-oophorectomy resulted in the successful prevention of recurrence of cerebral infarct for five years without antiplatelet or anticoagulant agents. In our patient, the surgical removal of adenomyosis was highly effective for preventing thrombosis in a patient with adenomyosis.

Keywords: adenomyosis; hypercoagulability; hysterectomy; multiple cerebral infarcts.

Figure 1.

A: Diffusion-weighted magnetic resonance imaging (DWI) revealed multiple infarctions on admission at the initial onset. B: DWI revealed recurrent cerebral infarctions.

Figure 2.

A: Sagittal T2-weighted image showed thickening of the posterior myometrium and multiple hypertense foci in the lesion (white arrow). B: A photomicrograph (original magnification, ×20; Hematoxylin and Eosin staining) showed islands of ectopic endometrial glands in the myometrium (black arrows).