P024 Vasculitis of the female genital tract: is it a single organ or systemic disease?
Authors: Nadin Thomas , Goadby Natalie , Smith Ruth 
Published: April 2023

Abstract

Background/Aims
Vasculitis of the female genital tract is rare. At one institution, incidence among all gynaecological surgeries was 0.15%. It is usually an incidental finding on histopathological examination after surgery done for another reason. Most commonly, it presents with vaginal bleeding, but can also present with pelvic pain, uterine prolapse, asymptomatic abdominal mass or atypical cervical smear. Constitutional and musculoskeletal symptoms are reported in about a quarter of cases. It can be localised to the female genital tract, most commonly the uterus and cervix. Less commonly, it can be part of a systemic vasculitis, including giant cell arteritis, polyarteritis nodosa, granulomatosis with polyangiitis, microscopic polyangiitis, cryoglobulinaemic vasculitis, lupus and rheumatoid vasculitis. Although data is limited, one review found 31.3% of cases to have systemic involvement. Approximately 60% of patients with vasculitis of the female genital tract and systemic vasculitis had GCA. In this group, about one third do not present with classical cranial, systemic or polymyalgia rheumatica symptoms. In localised disease, anaemia or raised inflammatory markers are unlikely. Histopathology mostly shows non-granulomatous inflammation. With systemic involvement, anaemia, raised inflammatory markers and granulomatous inflammation are more likely to be present. Localised vasculitis of the female genital tract tends not to require treatment. However, it can predate symptoms and signs of systemic disease. Therefore, follow-up for at least 12 months is recommended.

Methods
Written consent was obtained from the patient. Data was obtained from the patient's case notes, electronic records and histopathology results.

Results
We describe a 63-year-old lady with no past medical history and on no medications who presented with post-menopausal bleeding and abdominal cramping. Hysteroscopy showed two endometrial polyps. Biopsy showed grade 1A endometrial carcinoma. Total hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological analysis confirmed endometrial cancer but also showed some foci of granulomatous inflammation with multi-nucleating giant cells surrounding both small and medium calibre vessels. The vessels showed fibrinoid necrosis and disruption of the internal elastic lamina, suspicious for vasculitis. On review by the rheumatology team this lady was found to be well with no history of Raynaud’s; rashes; arthritis; ocular; ear, nose and throat; gastroenterological; respiratory; neurological; or constitutional symptoms. Examination was normal. C-reactive protein and immunoglobulins were normal. Anti-nuclear antibody, anti-neutrophil cytoplasmic antibody, rheumatoid factor and anti-CCP antibody were negative. Urine protein was raised at 0.29 (0-0.1) but protein/creatinine ratio was normal at 11 mg/mmol. Chest x-ray was clear.

Conclusion
In conclusion, female genital tract vasculitis is rare and is usually an incidental finding on histopathology. In this case, it appeared to be an isolated vasculitis of the female genital tract. It is important to recognise that uncommonly this condition can be associated with systemic involvement and therefore follow up in rheumatology clinic is recommended.
Disclosure
T. Nadin: None. N. Goadby: None. R. Smith: None.