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Giorgi M, Labanca L, Centini G, Lazzeri L, Martire FG, Sorrentino E, Mancini V, Raimondo D, Raffone A, Neola D, Aru AC, Habib N, Casadio P, Seracchioli R, Zupi E. Extrauterine adenomyoma: A case report and systematic review of the literature. Int J Gynaecol Obstet 2024; 164:869-901. [PMID: 37688388 DOI: 10.1002/ijgo.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/06/2023] [Accepted: 07/29/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To describe a case of extrauterine adenomyoma (EA) and review all the cases of EA in the literature. METHODS Pubmed/MEDLINE, Embase, and Google Scholar from 1807 to December 2022. All studies reporting the histologic diagnosis of an EA. We collected the following data: patient's age, size and location of adenomyoma, presence of endometriosis and adenomyosis, past gynecologic treatment, symptoms, diagnostic imaging, surgical intervention, alternative/adjuvant treatment, associated malignancy, and follow up. RESULTS Sixty-seven studies with 85 patients were included. Pain was the most frequent symptom (69.5%). Among diagnostic examinations, ultrasonography was used in 60 out of 81 reported cases, with several radiologic features described. EA was located inside the pelvis in 77.6% of patients. Adnexa were the most frequent site of the disease (24, 28.2%). History of endometriosis or adenomyosis was described in 35 patients (35, 41.2%). Uterine tissue morcellation was reported in 6 of the 85 patients (7.1%). Associated malignancy was detected in 9 out of 85 patients with available data (10.6%). There were two recurrences of disease. CONCLUSION Specific imaging features of EA are yet to be described in the literature. History of endometriosis and adenomyosis or uterine tissue morcellation may be suggestive of EA. Histologic examination can give a definitive diagnosis and exclude malignant transformation.
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Affiliation(s)
- Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Luca Labanca
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Francesco Giuseppe Martire
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Ester Sorrentino
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Virginia Mancini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Anna Chiara Aru
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Beaujon Hospital-University of Paris, Paris, France
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
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Dekkiche S, Dubruc E, Kanbar M, Feki A, Mueller M, Meuwly JY, Mathevet P. Accessory and cavitated uterine masses: a case series and review of the literature. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1197931. [PMID: 37662068 PMCID: PMC10469797 DOI: 10.3389/frph.2023.1197931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/04/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives The purpose of this study is to report nine patients of young women who underwent a surgical treatment of an accessory and cavitated uterine mass (ACUM) in our hospital between 2014 and 2022 and review all cases described in the literature. Material and methods The principal outcomes measured are the imaging techniques used to determine the diagnosis, the type of surgery used and the post-operative evolution of symptoms. We also report and analyse the 79 patients found in the literature since 1996 in addition to our 9 patients. Results Surgical excision is the only long-lasting treatment. Small invasive surgery with laparoscopic access is the gold standard and most widely used (83.0%). Some new therapeutic procedures have been recently described of which ethanol sclerotherapy seems very promising. Post-operatively, 54.5% of patients have a complete relief of symptoms. MRI is the best imaging technique to identify ACUM. Finally, we refine the description of this pathology and give a more precise definition of it. Conclusion Through our literature review and the analysis of our cases, we want to underline an important diagnostic criterion of this pathology: the fallopian tube on the homolateral side of the ACUM never communicates with the latter. It is a capital element for differential diagnosis.
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Affiliation(s)
- S. Dekkiche
- Gynaecology Department, Department Women-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - E. Dubruc
- Institute of Pathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - M. Kanbar
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - A. Feki
- Department of Obstetrics and Gynaecology, HFR Fribourg Hôpital Cantonal, Fribourg, Switzerland
| | - M. Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - J-Y. Meuwly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland
| | - P. Mathevet
- Gynaecology Department, Department Women-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland
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Chen Y, Deng L, Zhao J, Luo T, Zuo Z. Extrauterine adenomyoma of the lesser omentum: A case report and review of the literature. Medicine (Baltimore) 2022; 101:e30240. [PMID: 36086793 PMCID: PMC10980370 DOI: 10.1097/md.0000000000030240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The extrauterine adenomyoma is rare and it is extremely rare outside the pelvic cavity. Herein, we reported the first case of a single extrauterine adenomyoma occurring in the lesser omentum. PATIENTS CONCERNS This case involved a 55-year-old woman who had undergone subtotal gastrectomy and omentectomy for gastric carcinoma. During postoperational pathological examination, 1 lymph node-like mass was coincidentally found in the lesser omentum. The patient had a history of hysterectomy for uterine leiomyoma 8 years ago. DIAGNOSES The resected 17 "lymph nodes" from the lesser omentum were routinely checked for possible metastasis of gastric carcinoma. One of lymph node-like mass was microscopically showed that it was composed of benign smooth muscle components, endometrial glands and stroma by HE staining. Therefore, adenomyoma was initially considered. INTERVENTIONS The lymph node-like mass was removed together with the lesser omentum during the subtotal gastrectomy and omentectomy for gastric carcinoma. No special intervention was performed for the adenomyoma. OUTCOMES Immunohistochemical staining confirmed that smooth muscle tissue was diffusely and strongly positive for Desmin, smooth muscle actin, estrogen receptor, and progesterone receptor, and negative for CD117, Dog-1, S100, and CD34. Endometrial glands and stroma were positive for estrogen receptor and progesterone receptor, and the endometrium interstitium was also positive for CD10. The final diagnosis of extrauterine adenomyoma occurring in the lesser omentum was established. LESSONS So far, to the best of our knowledge, total 53 cases of extrauterine adenomyoma have been reported in 45 English reports. The most common location for a single mass was pelvic cavity (37 cases), but rarely outside the pelvic cavity. This is the first case of a single extrauterine adenomyoma occurring in the lesser omentum.
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Affiliation(s)
- Yanlin Chen
- Department of Pathology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Pathology, Jinshan Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 401122, China
| | - Liangyong Deng
- Department of Pathology, Jinshan Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 401122, China
| | - Jingbo Zhao
- Anbiping (Chongqing)Pathological Diagnosis Center, Chongqing, China
| | - Tianwen Luo
- Department of Pathology, Jinshan Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 401122, China
| | - Zhong Zuo
- Department of Pathology, Jinshan Hospital, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 401122, China
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Isolated Retroperitoneal Broad Ligament Endometriomas. J Minim Invasive Gynecol 2022; 29:807-809. [DOI: 10.1016/j.jmig.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022]
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5
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Malhotra V, Dahiya S, Nanda S, Chauhan M, Bhuria V. Accessory and Cavitated Uterine Mass: Is It a Müllerian-Duct Anomaly? J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vani Malhotra
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sonia Dahiya
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Smiti Nanda
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Meenakshi Chauhan
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Vandana Bhuria
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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A rare case of ovarian adenomyoma mimicking primary invasive ovarian cancer with a contralateral serous borderline ovarian tumor: A case report and review of the literature. Heliyon 2020; 6:e04406. [PMID: 32743088 PMCID: PMC7385463 DOI: 10.1016/j.heliyon.2020.e04406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/20/2020] [Accepted: 07/03/2020] [Indexed: 01/23/2023] Open
Abstract
Extrauterine adenomyoma is a rare type of benign tumor, characterized by nodular aggregate of smooth muscle, endometrial glands and endometrial stroma, arising outside the uterus. In this study we describe a case of primary ovarian adenomyoma associated with endometriotic cysts with contralateral serous borderline tumor in a 40-year-old woman and we highlight how preoperative exams could lead to the suspicious of invasive cancer. We provide a review of the literature, analyzing all cases of extrauterine adenomyoma published so far, classifying them on the basis of pathogenetic theories proposed, localization of the lesion, imaging modalities and treatment adopted.
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7
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Peyron N, Jacquemier E, Charlot M, Devouassoux M, Raudrant D, Golfier F, Rousset P. Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity. Eur Radiol 2018; 29:1144-1152. [PMID: 30159623 DOI: 10.1007/s00330-018-5686-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To describe MRI features of accessory cavitated uterine mass (ACUM) with surgical correlations. METHODS Eleven young women with an ACUM at pathology underwent preoperative pelvic MRI. Two experienced radiologists retrospectively analysed MR images in consensus to determine the lesion location within the uterus, its size, morphology (shape and boundaries), and structure reporting the signal and enhancement of its different parts compared to myometrium. The presence of an associated urogenital malformation or other gynaecological anomaly was reported. MRI features were correlated with surgical findings. RESULTS All 11 lesions were well correlated with surgical findings, lateralised (seven were left-sided), and located under the horn and the round ligament insertion. Nine were located within the external myometrium, bulging into the broad ligament. Two were extrauterine, entirely located within the broad ligament. On MRI, the mean size was 28 mm (range 17-60 mm). Nine lesions were round-shaped, two were oval; all had regular boundaries. At surgery, the ACUM were not encapsulated but were possible to enucleate. On MRI, all lesions were well defined and showed a central haemorrhagic cavity surrounded by a regular ring (mean thickness, 5 mm) which had the same signal compared to the junctional zone. ACUM was isolated in all women, without urogenital malformation, adenomyosis or deep endometriosis. CONCLUSIONS On MRI, ACUM was an isolated round accessory cavitated functional non-communicating horn-like aspect in an otherwise normal uterus. MRI may facilitate timely diagnosis and appropriate curative fertility-sparing laparoscopic resection. KEY POINTS • ACUM is rare, with delayed diagnosis in young women with severe dysmenorrhoea. Pelvic MRI facilitates timely diagnosis and appropriate curative fertility-sparing laparoscopic resection. • Quasi-systematically located under the uterine round ligament insertion, ACUM may be intramyometrial and/or in the broad ligament. • On MRI ACUM resemble a non-communicating functional accessory horn within a normal uterus; the mass, most often round-shaped, had a central haemorrhagic cavity surrounded by a regular ring which had the same low signal compared to the uterine junctional zone.
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Affiliation(s)
- N Peyron
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - E Jacquemier
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - M Charlot
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - M Devouassoux
- Pathology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon 1 Claude Bernard University, Lyon, France
| | - D Raudrant
- Lyon 1 Claude Bernard University, Lyon, France.,Gynaecology and Obstetrics Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
| | - F Golfier
- Lyon 1 Claude Bernard University, Lyon, France.,Gynaecology and Obstetrics Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
| | - P Rousset
- Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. .,Lyon 1 Claude Bernard University, Lyon, France.
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A case of uterus-like mass of the ovary associated with endometriosis. Case Rep Womens Health 2018; 16:1-3. [PMID: 29593999 PMCID: PMC5842961 DOI: 10.1016/j.crwh.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/31/2017] [Indexed: 11/22/2022] Open
Abstract
Coelomic metaplasia is considered to be one of the mechanisms resulting in endometriosis. Intense ceolomic metaplasia resulted in a uterine like mass (ULM) acquiring the structural integrity of a miniature uterus. ULM might be considered a rare manifestation in the spectrum of endometriosis development.
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Abstract
BACKGROUND Uterus-like mass (ULM) is an extremely rare lesion. Gross morphology of ULM resembling a uterus. It can occur in various organs in the abdominal cavity, even in the spinal cord. The histogenesis of ULM remains uncertain. A number of hypotheses have been proposed including metaplasia, congenital anomaly, and heterotopia theory. METHODS We describe a case of 43-year-old male presented with a complaint of acute low abdominal pain. Pelvic ultrasound found a large pelvic mass embedded in the broad ligament. RESULTS The mass contains a variable thickness smooth muscle layer lined with endometrial glands and stroma which resembling a uterus. Eventually, the patient was diagnosed as ULM by histopathological examination. CONCLUSION Except hypomenorrhea, the patient did not have any other associated abnormalities. We suggest this case supports the metaplasia theory that ULM is a benign mass formed by the proliferation of ectopic endometrial stromal cells or pluripotent mesenchymal cells of the 2nd Müllerian system.
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Affiliation(s)
- Jian He
- Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai
| | - Jie Xu
- School of Public Health, Xinxiang Medical University
| | - Hong-Yan Zhou
- Department of Pathology, The First People's Hospital of Xinxiang, Xinxiang, P. R. China
- Correspondence: Hong-Yan Zhou, Department of Pathology, The First People's Hospital of Xinxiang, 63 Yiheng Rd, Xinxiang 453000, P. R. China (e-mail: )
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Sopha SC, Rosado FGN, Smith JJ, Merchant NB, Shi C. Hepatic Uterus-Like Mass Misdiagnosed as Hepatic Abscess. Int J Surg Pathol 2014; 23:134-9. [DOI: 10.1177/1066896914534465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Hepatic endometriosis/uterus-like mass is rare and may be overlooked during hepatic cyst workups. We report a case of uterus-like mass, misdiagnosed as hepatic abscess. Case Report: A 47-year-old woman developed abdominal pain and vomiting. Infectious colitis with hepatic abscess was diagnosed, and remained antibiotic-refractory. Fine-needle aspiration and core biopsies showed benign contents. The patient presented to our institution with symptoms and normal blood work. Laparoscopic excision demonstrated a 1.4-cm cyst composed of endometrial glands (estrogen receptor+ and progesterone receptor+) and stroma (CD10+) with smooth muscle actin (SMA+), arranged in an organoid fashion. The patient, status-post hysterectomy, had no history or symptoms of endometriosis. Conclusion. This rare case illustrates the merit of considering uterus-like mass/endometriosis in the differential diagnosis of antibiotic-refractory hepatic cysts. Cyst heterogeneity may confound needle biopsy. We report the first instance of a hepatic uterus-like mass, with a review of related entities, postulated histogenesis, and important clinical associations.
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Affiliation(s)
| | | | - J. J. Smith
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Chanjuan Shi
- Vanderbilt University Medical Center, Nashville, TN, USA
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González RS, Vnencak-Jones CL, Shi C, Fadare O. Endomyometriosis ("Uterus-like mass") in an XY Male: Case Report With Molecular Confirmation and Literature Review. Int J Surg Pathol 2014; 22:421-6. [PMID: 24651910 DOI: 10.1177/1066896913501385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Male endometriosis and endomyometriosis (also termed "uterus-like mass") are 2 unusual manifestations of endometriosis. We report a case of male endomyometriosis with immunohistochemical and molecular confirmation. A 52-year-old man presented with stabbing pelvic pain. Computed tomography scan showed a mass in the right inguinal area, at the site of prior hernia repair. The lesion was tubular in shape, with a thick muscular wall and a central blood-filled lumen. Microscopically, the tissue showed layers of concentric smooth muscle, with endometrial glands and stroma lining the lumen. Many theories have been proposed regarding the etiology of both endomyometriosis and male endometriosis, including remnant rests of Müllerian tissue and metaplasia. Cases of male endometriosis typically have been linked to estrogen therapy for prostate cancer. Our patient had a history of cirrhosis and took spironolactone, possibly leading to an altered hormonal state that interacted with a reactive/metaplastic process at a site of prior surgery.
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Affiliation(s)
- Raul S González
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Chanjuan Shi
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Oluwole Fadare
- Vanderbilt University School of Medicine, Nashville, TN, USA
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Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril 2014; 101:472-87. [DOI: 10.1016/j.fertnstert.2013.10.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
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Huanwen W, Hui Z, Xiaowei X, Zhaohui L. Extrauterine adenomyoma of the liver with a focally cellular smooth muscle component occurring in a patient with a history of myomectomy: case report and review of the literature. Diagn Pathol 2013; 8:131. [PMID: 23915210 PMCID: PMC3771407 DOI: 10.1186/1746-1596-8-131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 07/25/2013] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Since first reported in 1986, 14 cases of extrauterine adenomyoma have been reported in the English literature, most often occurring in the ovaries. In this report, we present the first case of extrauterine adenomyoma involving the liver in a 29-year-old woman who presented with a 2-year history of low back pain with recent worsening and a history of laparoscopic myomectomy 5 years previously. Gross inspection of the specimen revealed a subcapsular mass that had a well-circumscribed margin with the adjacent liver tissue. By histopathologic examination, the multilobular mass was composed of a smooth muscle component and benign endometrioid glands and stroma. The smooth muscle component was focally cellular, and the endometrioid glands had secretory features. Both the smooth muscle component and endometrioid tissue were positive for ER and PR. The smooth muscle component was also positive for desmin and SMA, while the endometrioid stroma was positive for CD10. Other extrauterine lesions composed of a mixture of smooth muscle tissue and heterotopic endometrioid tissue, including endometriosis with a smooth muscle component, leiomyomatosis/leiomyomas associated with endometriosis and uterus-like masses, should be included in differential diagnoses. The patient was free from recurrence 5 months after liver tumor resection. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1327125766102291.
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Abscessed uterine and extrauterine adenomyomas with uterus-like features in a 56-year-old woman. Case Rep Obstet Gynecol 2013; 2013:238156. [PMID: 23956896 PMCID: PMC3730194 DOI: 10.1155/2013/238156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022] Open
Abstract
Adenomyosis, also known as endometriosis interna, is the presence of endometrial glands and stroma within the myometrium. Its localised form is called adenomyoma and mimics a leiomyoma. Rarely, adenomyomas are located outside the uterus and some of them form uterus-like masses with a thick muscle wall and an endometrium-lined central cavity. They are generally located in the ovary or broad ligament, and, although they are closely related to endometriosis, their pathogenetic mechanisms are different from each other. Müllerian duct fusion defect and subcoelomic mesenchyme transformation theory are two possible pathogenetic mechanisms for this rare entity. Here we report abscessed uterine and extrauterine adenomyomas forming uterus-like masses in the left and right broad ligament and an ectopic adrenal tissue in the left paraovarian region in a 56-year-old woman. Although there is a reported abscessed adenomyosis in the literature, this is the first abscessed extrauterine uterus-like masses with synchronous pelvic pathologies like endometriosis, leiomyomas, adenomyosis, an endometrial polyp, an endocervical polyp, and an ectopic adrenal tissue. This benign lesion gives the impression of leiomyoma, a uterine malformation, or even malignancy preoperatively. Frozen section helps in differential diagnosis.
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Abstract
The theory of müllerianosis predicts that embryonic müllerian tissue, misplaced during organogenesis, results in the formation of 4 benign müllerian diseases-developmental adenomyosis, endometriosis, endosalpingiosis, and endocervicosis-(developmental müllerian diseases) that will be identified in human female fetuses, infants, children, adolescents, and adults. Direct evidence is presented to support the existence of developmental adenomyosis, developmental endometriosis, and developmental endocervicosis in human female fetuses along with strong circumstantial evidence supporting the existence of all 4 developmental müllerian diseases in human female infants, children, adolescents, and adults. This evidence throws light upon the pathogenesis of rare müllerian lesions whose pathogenesis remains inexplicable by classical and modern theories. Furthermore, this research has scientific and clinical relevance: scientific relevance because it opens up a new field of comparative research-the 4 developmental müllerian diseases complement the 4 acquired müllerian diseases; clinical relevance because it identifies rare müllerian diseases curable by complete surgical excision.
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Affiliation(s)
- Ronald E Batt
- Department of Gynecology-Obstetrics, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.
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Kim HC, Yang DM, Kim SW, Kim GY, Choi SI, Park SJ. Uterus-like mass involving the appendix: US and CT findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:518-521. [PMID: 22806205 DOI: 10.1002/jcu.21964] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 05/30/2012] [Indexed: 06/01/2023]
Abstract
Uterus-like mass is a rare extrauterine mass composed of a central cavity lined by endometrium and surrounding smooth muscle. Uterus-like mass has frequently been reported in the ovary, but has rarely been found in extraovarian regions. We report a case of uterus-like mass involving the appendix in a woman who presented with right lower abdominal pain indistinguishable from acute appendicitis. Sonography revealed a heterogeneous mass of mixed echogenicity with inner cystic change, abutting the appendix. CT depicted an enhanced mass with inner cystic change abutting the appendix. Histopathologic examination confirmed the diagnosis.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Republic of Korea
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Carvalho FM, Carvalho JP, Pereira RMA, Ceccato BPV, Lacordia R, Baracat EC. Leiomyomatosis peritonealis disseminata associated with endometriosis and multiple uterus-like mass: report of two cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2012; 5:63-8. [PMID: 22661902 PMCID: PMC3364027 DOI: 10.4137/ccrep.s9530] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Leiomyomatosis peritonealis disseminate (LPD) is a rare benign disease of unknown etiology of women in reproductive age. A few reported cases of association with endometriosis have been described suggesting a possible origin from submesothelial multipotential cells. We present two cases of LPD associated with endometriosis expressing smooth muscle metaplasia, and some of the nodules with aspects of uterus-like mass. Laparoscopy, gross findings, and the pathological and immunohistochemical study of the surgical specimens were described. Our findings suggest an endometriotic origin for the LPD and indicate that the therapeutic approach might contemplate the surgical reduction of the nodules and endometriosis treatment.
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Affiliation(s)
- Filomena M Carvalho
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), Brazil
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Takeda A, Imoto S, Mori M, Yamada J, Nakamura H. Uterus-like mass of ovarian ligament: Image diagnosis and management by laparoendoscopic single-site surgery. J Obstet Gynaecol Res 2011; 37:1895-9. [PMID: 22070566 DOI: 10.1111/j.1447-0756.2011.01691.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Uterus-like mass composed of a cavity lined by mucosa resembling endometrium and surrounding smooth muscle layer simulating myometrium is an extremely rare disease entity of which the histogenesis is presently unknown. A 39-year-old, gravida 2, para 2, woman presented with sudden onset of lower abdominal pain and was found to have left adnexal mass with unusual image diagnostic appearance. The adnexal mass arising from the left ovarian ligament was excised by laparoendoscopic single-site surgery. Histopathological diagnosis was uterus-like mass of ovarian ligament.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Gifu, Japan.
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Seki A, Maeshima A, Nakagawa H, Shiraishi J, Murata Y, Arai H, Kubochi K, Kuramochi S. A subserosal uterus-like mass presenting after a sliding hernia of the ovary and endometriosis: a rare entity with a discussion of the histogenesis. Fertil Steril 2011; 95:1788.e15-9. [DOI: 10.1016/j.fertnstert.2010.11.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 11/17/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
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The Cavitated Accessory Uterine Mass: A Müllerian Anomaly in Women With an Otherwise Normal Uterus. Obstet Gynecol 2011; 117:733-734. [DOI: 10.1097/aog.0b013e31820cdb3e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Cavitated Accessory Uterine Mass: A Müllerian Anomaly in Women With an Otherwise Normal Uterus. Obstet Gynecol 2011. [DOI: 10.1097/aog.0b013e31820ce30e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus. Obstet Gynecol 2010; 116:1101-9. [PMID: 20966695 DOI: 10.1097/aog.0b013e3181f7e735] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present clinical cases of women who had an accessory and cavitated noncommunicating uterine mass with functioning endometrium associated with a normal uterus, suggestive of a new type of Müllerian anomaly. METHODS We report on five institutional cases: four cases of cavitated accessory uterine mass and a case of true adenomyoma. A review of the literature was performed by looking for these terms and others related in MEDLINE. RESULTS Including ours, there are 18 cases in the literature showing an accessory cystic cavity lined by endometrioid epithelium with an otherwise normal uterus. Another 11 cases only partially fulfilled the inclusion criteria. All of the first cases were in young women presenting with severe dysmenorrhea (n=4). Generally, the tumor was located in the anterior wall of the uterus at the level of insertion of the round ligament. It presents a certain similarity with the cavitated true adenomyomas observed in older women in whom the endometrial lining of the cystic cavity is generally absent. For differential diagnosis with cavitated noncommunicating rudimentary uterine horns, hysterosalpingography showing a normal eutopic uterine cavity is decisive. CONCLUSION Noncommunicating accessory uterine cavities and isolated cystic adenomyomas correspond to the same pathology: cavitated accessory uterine mass associated with an otherwise normal uterus. They present problems of differential diagnosis with true cavitated adenomyomas and cavitated rudimentary uterine horns. Accessory uterine mass could be caused by duplication and persistence of ductal Müllerian tissue in a critical area at the attachment level of the round ligament, possibly related to a gubernaculum dysfunction. LEVEL OF EVIDENCE III.
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Batt RE. Pathogenesis of a parauterine uterus-like mass: developmentally misplaced müllerian tissue--müllerianosis. Fertil Steril 2010; 94:e45. [PMID: 20493472 DOI: 10.1016/j.fertnstert.2010.04.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 04/15/2010] [Indexed: 11/25/2022]
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