Diffuse uterine leiomyomatosis with hemorrhage

A 28-year-old woman with primary infertility and severe menorrhagia underwent a hysterectomy after failed hormonal therapy for multiple leiomyomas. The postoperative pathologic findings established the diagnosis of diffuse uterine leiomyomatosis, which demonstrated histologic, immunohistochemical, and ultrastructural similarity to leiomyomas of the uterus. The rapid growth of the tumor coincided with the administration of clomiphene citrate, an estrogenic agonist. As with the common leiomyoma, intralesional hemorrhage in this case of diffuse leiomyomatosis was associated with norethindrone acetate treatment given after the cessation of clomiphene therapy.