Postablation neuroma of the myometrium—a report of 5 cases

Cramer SF, Stewart F. Cramer, Debra S. Heller
Human pathology · 2017 · vol. 67 , pp. 211–216 · doi:10.1016/j.humpath.2017.08.013 · PMID:28843713 · W2746359691
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This report details five cases of neuroma formation within the myometrium following uterine ablation procedures.

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Abstract

When hysterectomy is performed for chronic pelvic pain, routine pathology examination often provides no explanation. However, analysis of small uterine nerves using immunostains may help to address this deficiency. Small uterine nerves tend to be sparse or absent in wide areas of normal myometrium. Some studies of uterine nerves have suggested that endometriosis, adenomyosis, and fibroids are not inherently painful, with increased small nerves in the inner uterine wall associated with the history of pelvic pain. Although such areas may appear normal on hematoxylin and eosin (H&E), we have found a subtle inner wall lesion termed inner myometrial elastosis, best detected with trichrome or elastic stains, which may be a reaction to microscopic tears of inner myometrium. Such tears may induce increased inner wall innervation via the generation of nerve growth factor in granulation tissue. In the course of studying uterine nerves with immunostains, we found 5 cases with florid nerve proliferation, after deep endometrial ablation for abnormal uterine bleeding led to increased pelvic pain. We suggest that immunostains for postablation neuromas should be done in hysterectomies when pelvic pain increases after endometrial ablation. This may offer gynecologists and their patients an objective finding with a rational, scientific explanation for the pelvic pain.

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Condition tags

chronic_pelvic_pain

MeSH descriptors

Endometrial Ablation Techniques Endometrial Neoplasms Myometrium Neuroma Neurons Uterine Hemorrhage Adult Biopsy Chronic Pain Chronic Pain Chronic Pain Endometrial Ablation Techniques Endometrial Neoplasms Endometrial Neoplasms Endometrial Neoplasms Female Humans Hysterectomy Immunohistochemistry Middle Aged

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References (29)

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