The abstract for the Poster 2004 Biennial Meeting of the ASCCP in J Low Gen Tract Dis 2004;8(3) entitled, “Extrauterine Adenomyoma with Uterine-like Features Presenting 22 Years after Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy,” by R Redman, EJ Wilkinson, and NA Massoll, was omitted erroneously from the last issue and is presented below.
Extrauterine Adenomyoma with Uterine-like Features Presenting 22 Years after Total Abdominal Hysterectomy and Bilatera Salpingo-oophorectomy
Rachel Redman,1EJ Wilkinson,2NA Massoll3
Departments of1Pathology,2Immunology, and3Laboratory Medicine, University of Florida/Shands Hospital, Gainesville, FL
Objective. A report of an extrauterine adenomyoma with uterine-like features occurring 22 years after a total abdominal hysterectomy and bilateral salpingo-oophorectomy is presented with a review of the literature.
Materials and Methods. The patient was a 50-year-old woman with a 7-month history of recurrent urinary tract infections. Imaging studies revealed a stricture at the left ureterovesical junction and associated hydroureteronephrosis secondary to a large pelvic mass measuring 7.0 to 8.0 cm that encased the distal left ureter at the level of the pelvic brim and below. Exploratory laporatomy was performed with surgical excision of the mass.
Results. The specimen consisted of a pear-shaped, firm mass, measuring 5.0 × 5.0 × 4.0 cm, with a cystic center. On sectioning, approximately 50 mL of dark-brown, viscous fluid was exuded, revealing an interior of multiple polyp-like structures and an adherent blood clot within a dense white stroma. Microscopic evaluation showed a cyst wall containing endometrial stroma and glands. The endometrial glands had weakly secretory features as well as morular metaplasia. A prominent smooth muscle component, compatible with myometrium, comprised the outer aspect of the mass. Areas of endometrium were found within smooth muscle, consistent with adenomyosis. Variable amounts of blood and hemosiderin-laden macrophages were found throughout the mass. A diagnosis of extrauterine adenomyoma with uterine-like features was made.
Conclusions. Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is a rare entity. In addition, this mass had uterus-like features including a pear-like shape, uterine-type smooth muscle, and a cavity lined by functional endometrial glands and stroma. Only four other cases of an extrauterine uterine-like mass have been reported in the literature. Three involved the ovary, whereas one was located adjacent to the broad ligament with normal pelvic organs. Although none of these other uterine-like masses were described as adenomyomas with uterine-like features, the histologic findings are strikingly similar. This is the first case report of an extrauterine uterine-like mass found 22 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy.
Key Words: extrauterine adenomyoma, uterine-like mass, pelvic mass