Subserosal mass-like adenomyosis: Is it polypoid endometriosis

Endometrial tissue is considered ectopic in the uterus if it is present on the uterine serosa (endometriosis) or if it is located excessively deep in the myometrium (adenomyosis). Occasionally, adenomyosis can be seen grossly as an enlarged and globular uterus because of the myometrial hypertrophy accompanies it. A 58-year-old woman underwent vaginal hysterectomy and bilateral salpingo-oophorectomy for endometrial polyp and suspected subserosal leiomyoma. Thus, she was found to have an endometrial polyp and diffuse adenomyosis. Histopathological examination of the subserosal nodule revealed adenomyosis instead of leiomyoma. Subserosal nodular formations of adenomyosis, mimicking leiomyoma is possible even without significant enlargement of the uterus.

Subserozal kitle benzeri adenomyozis: Polipoid endometriozis

Endometriyal doku uterin serozada (endometriyozis) ya da myometriyum içinde (adenomyozis) yerlesmis ise ektopik olarak değerlendirilir. Arasıra, gross incelemede eslik eden myometriyal hipertrofi nedenli uterus büyümüs ve globuler bir hal almıs olabilir. 58 yasında kadın bir hastada endometriyal polip ve subserozal leiomyom ön tanısı ile vajinal histerektomi ve bilateral salpingoooferektomi yapılmıstır. Sonuçta endometriyal polip ve yaygın adenomyozis saptanan hastada, subserozal kitlenin histopatolojik incelemesinde leiomyom yerine adenomyozis izlenmistir. Subserozal nodüler gelisim gösteren adenomyozis, uterusta belirgin bir büyümeye neden olmadan da leiomyomu taklit edebilir.

PDF

___

1. Ota H, Igarashi S, Hatazawa J, Tanaka T. Is adenomyosis an immune disease? Hum Reprod Update 1998; 4(4): 360–7.

2. Sakamoto A. Subserosal adenomyosis: a possible variant of pelvic endometriosis. Am J Obstet Gynecol 1991; 165(1): 198–201.

3. Keating S, Quenville NF, Korn GW, Clement PB. Ruptured adenomyotic cyst of the uterus--a case report. Arch Gynecol 1986; 237(3): 169–73.

4. Goldblum JR, Clement PB, Hart WR. Adenomyosis with sparse glands. A potential mimic of low-grade endometrial stromal sarcoma. Am J Clin Pathol 1995; 103(2): 218–23.

5. Azziz R: Adenomyosis: Current perspectives. Obstet Gynecol Clin North Am 1989; 16: 221– 235.

6. Ferenczy A: Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4: 312–322.

7. Tulandi T: Adenomyosis: An old disease deserving a new attention. Hum Reprod Update 1998; 4: 311.

8. Sammour A, Pirwany I, Usubutun A, Arseneau J, Tulandi T. Correlations between extent and spread of adenomyosis and clinical symptoms. Gynecol Obstet Invest 2002; 54(4): 213–6.

9. Fukunaga M. Tumor-like cystic endosalpingiosis of the uterus with florid epithelial proliferation. A case report. APMIS 2004; 112(1): 45–8.

10. Matarese G, De Placido G, Nikas Y, Alviggi C. Pathogenesis of endometriosis: natural immunity dysfunction or autoimmune disease? Trends Mol Med 2003; 9(5): 223–8.

11. Hulka CA, Hall DA, McCarthy K, Simeone J. Sonographic findings in patients with adenomyosis: can sonography assist in predicting extent of disease? AJR Am J Roentgenol 2002; 179(2): 379–83.

12. Dadmanesh F,Young RH, Clement PB(1999) Polypoid endometriosis. A clinicopathologic analysis of 15 cases (abstract). Mod Pathol 12:115A.

13. Heatley MK, Russell P. Florid cystic endosalpingiosis of the uterus. J Clin Pathol 2001; 54(5): 399–400.

14. Gilks CB, Clement PB, Hart WR, Young RH. Uterine adenomyomas excluding atypical adenomyomas and adenomyomas of the endocervical type: a clinicopathologic study of 30 cases of an underemphasized lesion that may cause diagnostic problems with brief consideration of adenomyomas of other female genital tract sites. Int J Gynecol Pathol 2000; 19: 195–205.