An uncommon companion to prolapse: Mönckeberg's medial calcific sclerosis of the uterine vasculature

Abstract

Mönckeberg's arteriosclerosis, or medial calcific sclerosis, is an uncommon, non-atherosclerotic form of vascular calcification affecting the tunica media of small- and medium-sized muscular arteries. It occurs independently of intimal atherosclerotic disease, is typically non-obstructive, and is most often encountered in the peripheral arteries of the lower limbs in elderly patients, diabetics, and those with chronic kidney disease. Involvement of the uterine vasculature is exceedingly rare, with only a handful of cases described worldwide. We report a 60-year-old postmenopausal woman with no identifiable metabolic risk factors who presented with third-degree utero-vaginal prolapse and underwent vaginal hysterectomy with anterior colporrhaphy. Histopathological examination of the surgical specimen incidentally revealed medial calcific sclerosis of the uterine vessels, in addition to chronic cervicitis and senile cystic atrophy of the endometrium. This case adds to the sparse literature on Mönckeberg's arteriosclerosis at an atypical, visceral site and highlights the importance of histopathological vigilance in recognising this entity even in patients without conventional risk factors.