Endometrioid adenocarcinoma arising in adenomyosis – difficulties in diagnostics

Introduction:

Endometrial carcinoma is the most prevalent cancer of the female genital organs with an estimated number of 10.700 new cases in Germany each year. The uterine adenomyosis is a very common benign change, defined as ectopic endometrial gland and stroma cells located in the uterine myometrium. While endometrial carcinoma presents as malignant transformation of the intracavitary layer, there are only rare cases reported, in which endometrial carcinoma raised from adenoymosis.

Case:

Hysteroscopy and curettage was performed on an asymptomatic 67-year old woman due to a sonographically unspecific, semicircular hyperechogenic structure in the lower part of the posterior uterine wall. Combined hormone replacement therapy was taken since her early menopause, postmenopausal bleeding did not occur. Histological results showed a benign cervical polyp and no evidence of malignancy. Eight weeks later the sonographic findings persisted. Imaging by MRI showed an unclear leason located supracervically, mainly in the endometrium with infiltration of the myometrium, thus endometrial carcinoma could not be ruled out. Histological examination after laparoscopic hysterectomy confirmed an endometrioid adenocarcinoma arising from an atypical polypoid adenomyoma of the uterus.

Conclusion:

Endometrial carcinoma arising entirely in adenomyosis is a rare disease. Symptoms like postmenopausal bleeding may be absent and diagnostic curettage may not prove evidence of malignancy. Preoperative diagnosis, therefore, is a challenge. Imaging can be the main diagnostic tool, even if their findings may be rather unspecific. Hysterectomy should be considered in cases of unclear findings.