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Lymphocytic vasculitis of the uterus in a patient with melanoma receiving ipilimumab.

Case Report A 77-year-old woman developed in-transit and lymphatic metastases from melanoma after multiple previous therapies. She received four dosesof ipilimumab3mg/kgbeginninginSeptember2011.Fifteenweeks after starting treatment, she developed hypophysitis with low levels of cortisol and thyroid-stimulating hormone; her symptoms responded to appropriate hormonal replacement. Positron emission tomography (PET)/computed tomography scan in May 2012 documented complete remission of her melanoma. She received additional doses of ipilimumab 3 mg/kg in March and June 2012 without apparent adverse effects. A routine PET/computed tomography scan in August 2012 appeared to show a 4.8-cm mass in the uterus (SUV 9.2) with bilateral iliac lymphadenopathy (Fig 1). She had no pelvic pain, bleeding, or previous gynecological disease. Because of suspicion of recurrent malignancy she had a hysterectomy in September 2012. Pathology showed lymphocytic vasculitis involving uterine and ovarian vessels (Fig 2), with transmural infiltration of lymphocytes and focal fibrin deposition. The iliac lymph nodes thatwereremovedshowedonlyreactivechanges.Serologic studies subsequently showed normal antinuclear antibodies but a high titer of antithyroglobulin antibody—3,591 IU/mL (normal, 0-40 IU/mL).