Tumorlike Endmetriosis Mimicking Uterine Sarcoma

Background Adenomyosis of the uterus is a common disease and accounts for up to 50% of women (Chapron et al. 2020). Mostly, it represents as microscopic diagnosis but may appear as nodular lesion. Uterine adenomyoma (AM) represent a very rare lesion (Gilks et al. 2000) and most commonly occur as atypical adenomyomas within the endometrium (Tahlan et al. 2006), but very rarely within the uterine wall. Here we describe a case of (non-atypical) AM with clinically rapid growth mimicking uterine sarcoma.

Case Report A 50-year-old women (0G/0P) presented with hyper- and dysmenorrhea and fast growing nodular uterine lesion. Preoperative CT-scan was suspicious for uterine sarcoma. The resection specimen from TAH represented a 1240g uterus (19 x 15 x 11 cm). The whole uterine corpus was involved by sharp circumscribed nodular lesion of 13.5 x 12.5 x 10.5 cm with somewhat whirled cutting surface with occasionally blueish cysts without necroses and/or haemorrhage. Separately a myxoid fasciculated lesion of 4.5 x 4 x 3 cm was seen. On intraoperative frozen section examination the diagnosis of nodular adenomyosis and myxoid leiomyoma was made. The diagnosis of nodular adenomyosis was changed into uterine adenomyoma on final histopathology with strong and diffuse immunoexpression of estrogen receptor but negative staining for SATB-2.

Conclusion Uterine adenomyosis is often an incidental microscopic lesion (Garcia & Isaacson 2011), but may appear on gross examination by focally or diffusely thickened, trabeculated myometrium (Clement et al. 2020). Uterine adenomyoma is defined as a discrete leiomyoma-like uterine mass which microscopically is composed of an admixture of endometrial glands, endometrial stroma, surrounded by smooth muscle cells (Gilks et al. 2000, Tahlan et al. 2006). The main differential diagnosis of uterine AM clinically include uterine fibroids and uterine sarcomas and for the pathologists nodular adenomyosis, biphasic epithelial-mesenchymal uterine lesions as adenosarcomas and different types of uterine sarcomas. Especially in large cases with rapid growth, uterine (intramural) adenomyomas may clinically mimicking uterine sarcoma.

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Artikel online veröffentlicht:
10. Juni 2022