51
|
Mandal S, Mahajan D, Khurana N. Ovarian adenomyoma mimicking an ovarian malignancy: a case report with literature review. Int J Surg Pathol 2008; 17:38-40. [PMID: 18397899 DOI: 10.1177/1066896908315811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Smooth muscle tumors of the ovary are rare, and ovarian adenomyoma are even rarer. It is a well-circumscribed biphasic tumor composed of benign glands and smooth muscle cells, as well as a variety of pseudoneoplastic glandular lesion. After extensive literature search, the case presented in this article appears to be the third case of an ovarian adenomyoma and the first case in a postmenopausal woman.
Collapse
Affiliation(s)
- Shramana Mandal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | | | | |
Collapse
|
52
|
Grimbizis GF, Mikos T, Zepiridis L, Theodoridis T, Miliaras D, Tarlatzis BC, Bontis JN. Laparoscopic excision of uterine adenomyomas. Fertil Steril 2008; 89:953-61. [PMID: 17612535 DOI: 10.1016/j.fertnstert.2007.04.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 04/17/2007] [Accepted: 04/17/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To present a series of six consecutive women with adenomyomas who were successfully managed with a standard treatment strategy to elucidate the feasibility and the effectiveness of laparoscopic treatment of adenomyomas. DESIGN Cross-sectional case series. SETTING(S) Obstetrics and gynecology department of a tertiary academic hospital and endoscopic unit of a private hospital. PATIENT(S) The six cases described in this report were nonpregnant women of reproductive age (mean age, 34.8 years old; range, 29-38 years) who presented in the outpatient gynecological clinic for yearly routine visit (one patient), dysmenorrhea and menorrhagia (three patients), and history of pregnancy loss (two patients). INTERVENTION(S) Laparoscopic excision of uterine adenomyomas. MAIN OUTCOME MEASURE(S) Feasibility and effectiveness of laparoscopic management of adenomyomas. RESULT(S) The average operating time was 100.5 minutes, and the average estimated blood loss was 163 mL. No event complicated the intraoperative and the postoperative course of these cases, and no case was converted to laparotomy. The mean follow-up was 13.7 months, with complete regression of the symptoms. CONCLUSION(S) Excision of adenomyomas presents intraoperative peculiarities involving difficulties in their dissection and manipulation. Laparoscopic management of these lesions appears to be safe and feasible with good follow-up results and limited recurrence rates.
Collapse
Affiliation(s)
- Grigoris F Grimbizis
- First Department of Obstetrics and Gynecology, Medical Faculty, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
| | | | | | | | | | | | | |
Collapse
|
53
|
Protopapas A, Milingos S, Markaki S, Loutradis D, Haidopoulos D, Sotiropoulou M, Antsaklis A. Cystic Uterine Tumors. Gynecol Obstet Invest 2008; 65:275-80. [DOI: 10.1159/000113871] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 06/15/2007] [Indexed: 11/19/2022]
|
54
|
Kingston GT, Manek S. Endometrial glands and stroma within uterine smooth muscle proliferations: an introduction of the concept of an adenomyotic leiomyoma. Histopathology 2007; 51:721-3. [DOI: 10.1111/j.1365-2559.2007.02835.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
55
|
Oliva E, de Leval L, Soslow RA, Herens C. High Frequency of JAZF1-JJAZ1 Gene Fusion in Endometrial Stromal Tumors With Smooth Muscle Differentiation by Interphase FISH Detection. Am J Surg Pathol 2007; 31:1277-84. [PMID: 17667554 DOI: 10.1097/pas.0b013e318031f012] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The most common cytogenetic alteration observed in low-grade endometrial stromal tumors (EST) is the t(7;17)(p15;q21) translocation, resulting in the fusion of the JAZF1 and JJAZ1 genes. By reverse-transcription polymerase chain reaction, the translocation has been detected overall in one-third of ESTs, but only rarely in its variants. The purpose of this study was to develop a fluorescence in situ hybridization assay for detection of this translocation using archival paraffin-embedded samples of ESTs with smooth muscle differentiation and to assess the nature of the smooth muscle component of these tumors. Representative paraffin blocks of 9 endometrial stromal nodules and 1 low-grade endometrial stromal sarcoma were collected for the study. In 1 case, the block selected also contained areas of sex cordlike differentiation. A fluorescence in situ hybridization probe set was designed to detect the t(7;17)(p15;q12) on tissue sections. Six out of 10 collected ESTs were assessable. Fusion signals were detected in 3 out of 6 cases (50%) in both the conventional endometrial stromal and the smooth muscle components of the tumors. The tumor sample with sex cordlike differentiation harbored the fusion signal in all the 3 components. Our results support the contention that the endometrial stromal and smooth muscle components of these tumors have the same origin, either from a common precursor cell with pluripotential differentiation or from endometrial stromal cells that have undergone smooth muscle metaplasia. Our results indicate that the detection of this chromosomal abnormality can be used to diagnose ESTs with smooth muscle differentiation when the smooth muscle component is predominant.
Collapse
MESH Headings
- Cell Transformation, Neoplastic
- Chromosomes, Human, Pair 17
- Chromosomes, Human, Pair 7
- Co-Repressor Proteins
- DNA, Neoplasm/analysis
- DNA-Binding Proteins
- Endometrial Stromal Tumors/genetics
- Endometrial Stromal Tumors/pathology
- Female
- Gene Fusion
- Humans
- In Situ Hybridization, Fluorescence/methods
- Middle Aged
- Myocytes, Smooth Muscle/pathology
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Sarcoma, Endometrial Stromal/genetics
- Sarcoma, Endometrial Stromal/pathology
- Stromal Cells/pathology
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Translocation, Genetic
Collapse
Affiliation(s)
- Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | |
Collapse
|
56
|
Kitajima K, Imanaka K, Kuwata Y, Hashimoto K, Sugimura K. Magnetic Resonance Imaging of Typical Polypoid Adenomyoma of the Uterus in 8 Patients. J Comput Assist Tomogr 2007; 31:463-8. [PMID: 17538297 DOI: 10.1097/01.rct.0000243447.03116.0c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the magnetic resonance imaging findings of typical polypoid adenomyoma and correlate radiological findings with histopathologic findings. METHODS Magnetic resonance imaging and histopathologic findings were retrospectively reviewed in 8 patients. The size, location, polyp's shape, and signal intensity of magnetic resonance imaging findings were evaluated. RESULTS The polyp's shape of 8 cases is pedunculated in 7 and sessile in 1, and all 8 cases are well circumscribed. Four cases (50%) show an isointense mass relative to the myometrium with small or large hyperintense foci on T1-weighted imaging (T1WI) or T2-weighted imaging (T2WI), reflecting the fascicle of smooth muscle with islands of hemorrhagic endometrial tissue. One case forms a large hemorrhagic cavity, being hyperintense on T1WI and hypointense on T2WI. Three cases (37%) show almost homogeneous isointense or hyperintense mass on T2WI. CONCLUSIONS When there is a well-defined polypoid mass protrusion into the uterine endometrial cavity that is isointense relative to the myometrium with small or large foci of high signal on T1WI or T2WI in a premenopausal woman, typical polypoid adenomyoma can be considered in the differential diagnosis.
Collapse
|
57
|
Abstract
The aim of this study is to highlight the importance of diagnosing uterine adenomyoma and help in differentiating it from other sinister lesions. Adenomyoma of the uterus is a circumscribed nodular aggregate of benign endometrial glands surrounded by endometrial stroma with leiomyomatous smooth muscle bordering the endometrial stromal component. It may be located within the myometrium, or it may involve or originate in the endometrium and grow as a polyp. A retrospective analysis of 26 consecutive cases of uterine adenomyomas diagnosed in the Department of Pathology, Government Medical College, Chandigarh from January 1994 to December 2004 was done, and their clinical and histological features were analyzed. The criterion used for case identification was a circumscribed mass composed of benign endometrial glands with a stromal component consisting of endometrial type stroma surrounded by leiomyomatous smooth muscle. Mitotic figures were counted within 50 high-power fields (hpf) and recorded as the highest number per 10 hpf. The age of the patients ranged from 22 to 60 years (mean age, 41 years). The most common presenting symptom was abnormal vaginal bleeding (n = 15). Thirteen patients underwent panhysterectomy; 7, total hysterectomy; 1, subtotal hysterectomy; 4, polypectomy or tumor removal; and 1, curettage. Of the 26 cases of adenomyoma, 24 were in the corpus, 1 was in the cervix, and 1 was in the broad ligament. An associated leiomyoma was noted in 12 cases (46.9%). The adenomyomas were firm in consistency and, on cut section, showed a gray-white surface. Five tumors showed cystic spaces filled with dark brown material. On microscopic examination, the tumors were well demarcated from the surrounding structures. The endometrial glands were mostly tubular and showed relatively regular spacing from each other without any back-to-back arrangement. The glands were lined by benign proliferative pseudostratified columnar epithelium. An occasional typical mitotic figure was noted in these glands in a few cases. The glands were surrounded by endometrial stroma which was compact and spindly. This stroma was, in turn, bordered by leiomyomatous smooth muscle. Thick-walled blood vessels were commonly observed. One to two typical mitotic figures per 10 hpf were noted in the endometrial stroma in few cases; however, no mitosis was noted in the myometrial component. Associated adenomyosis was also noted in 8 cases (30.8%). Adenomyomas have to be distinguished from a number of other lesions, for example, adenomyosis, leiomyoma with entrapped glands, atypical polypoid adenomyoma, endometrial polyps, adenofibroma, and adenosarcoma. This study highlights the importance of correctly identifying this fairly common entity and helps to distinguish adenomyoma from other similar appearing benign and malignant lesions.
Collapse
Affiliation(s)
- Anita Tahlan
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | | | | |
Collapse
|
58
|
Abstract
We report on an unusual endometrial polyp in a postmenopausal woman taking tamoxifen for 7 years after surgical resection of a breast carcinoma. A 63-year-old woman with endometrial thickening was submitted to hysteroscopy with biopsy, which revealed a polyp with a sex cord-like pattern. The hysterectomy specimen showed florid adenomyosis, and in the background, there were rare sex cord-like foci. Immunohistochemistry can be useful in differentiating sex cord-like elements from metastatic breast cancer to endometrium. This is, to our knowledge, the first observation in literature correlated to tamoxifen intake.
Collapse
Affiliation(s)
- Maísa Momesso De Quintal
- Department of Anatomic Pathology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil
| | | |
Collapse
|
59
|
Tamai K, Koyama T, Umeoka S, Saga T, Fujii S, Togashi K. Spectrum of MR features in adenomyosis. Best Pract Res Clin Obstet Gynaecol 2006; 20:583-602. [PMID: 16564228 DOI: 10.1016/j.bpobgyn.2006.01.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Magnetic resonance (MR) imaging is a highly accurate non-invasive technique for the diagnosis of adenomyosis. Typical MR features include either diffuse or focal thickening of the junctional zone or an ill-defined area of low signal intensity in the myometrium on T2-weighted MR images. Occasionally, the islands of ectopic endometrial tissue can be identified as punctate foci of high signal intensity. Less commonly, adenomyosis can present as a well-circumscribed form known as adenomyoma, adenomyotic cyst characterized by the presence of haemorrhagic cyst, or adenomyomatous polyp protruding into the uterine cavity. The MR appearances of adenomyosis may occasionally fluctuate in response to hormonal stimulation and treatment. MR imaging is helpful not only in monitoring the treatment effect of hormonal therapy, but also in predicting therapeutic effect. In cases of endometrial cancer in the uterus with adenomyosis, evaluation of myometrial invasion may become difficult. Rarely, endometrial cancer may arise directly from adenomyosis resulting from malignant transformation of endometrial glands, creating diagnostic challenges. Differential diagnosis of adenomyosis on MR imaging include physiological myometrial contraction and almost all myometrial lesions, and they should be carefully differentiated from adenomyosis by identifying typical clinical and MR features in these lesions. Precise knowledge of the spectrum of MR features in adenomyosis greatly helps in determining an accurate diagnosis and appropriate management of the patients.
Collapse
Affiliation(s)
- Ken Tamai
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | |
Collapse
|
60
|
Abstract
Adenomyosis is defined by the presence of endometrial mucosa within the myometrium. This probably occurs by invagination of the basalis endometrium into the myometrium. The process of invagination and intramyometrial spreading may be facilitated by the non-cyclic, anti-apoptotic activity of the basalis associated with relative hyper-oestrogenic states. Most cases of adenomyosis are discovered in multiparous women during the 'transitional' years (40-50 years), and the condition is associated with menorrhagia, dysmenorrhoea, endometrial polyps and leiomyomata uteri. Endometrioid adenocarcinoma is often associated with adenomyosis, is frequently of early stage and low histological grade, is hormone-sensitive, and has an excellent prognosis. Extension of malignant growth into foci of adenomyosis has no adverse effect on prognosis. Definite diagnosis and treatment of adenomyosis are obtained by hysterectomy. Although adenomyotic endometrial glands are hormone-sensitive, exogenous progestogenic agents are ineffective for the treatment of adenomyosis. Anti-oestrogenic danazol and gonadotrophin-releasing hormone (GnRH) analogues induce suppression of adenomyosis, but their use must be of short duration. Surgical extirpation, therefore, is the best therapeutic option.
Collapse
|
61
|
Abstract
Adenomyosis of the uterus is a common condition amongst women in their reproductive years. It is defined as the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The common presenting symptoms are painful and heavy periods and infertility, although many women are asymptomatic. Adenomyosis is thought to affect 1% of women and is typically diagnosed in the 4th and 5th decades of life. The aetiology is unclear, and until recently a diagnosis was made only after invasive and destructive surgery. With the advent of improved imaging of the pelvic organs, and in particular magnetic resonance imaging, the diagnosis of adenomyosis is being made more frequently. Unfortunately, because the disease has been infrequently diagnosed prior to hysterectomy, there are few well-designed studies of medical or surgical management. Management with hormonal treatment that aims to reduce the proliferation of endometrial cells is promising, but there is a paucity of well-designed studies to guide treatment. Hysterectomy or use of the levonorgestrel intrauterine system (LNG-IUS) remains the mainstay of treatment.
Collapse
Affiliation(s)
- Cynthia Farquhar
- Department of Obstetrics and Gynaecology, National Womens' Health at Auckland, City Hospital, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | | |
Collapse
|
62
|
Chopra S, Lev-Toaff AS, Ors F, Bergin D. Adenomyosis:common and uncommon manifestations on sonography and magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:617-27; quiz 629. [PMID: 16632786 DOI: 10.7863/jum.2006.25.5.617] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The purpose of this presentation is to show the imaging findings of the common and uncommon variants of adenomyosis as seen on sonography and magnetic resonance imaging (MRI). METHODS A 3-year database search was performed to identify women who had pelvic sonography and pelvic MRI within a 6-month interval. Images of these cases were retrospectively reviewed. RESULTS Eighty women were identified. Adenomyosis was diagnosed on MRI, which was used as the reference standard, in 45 of these women. The correct diagnosis was made on sonography in 73% of the cases. CONCLUSIONS Awareness of the spectrum of imaging features of adenomyosis is important to use sonography effectively for diagnosing this entity and to help avoid misdiagnosis.
Collapse
Affiliation(s)
- Sheetal Chopra
- Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | | | | | | |
Collapse
|
63
|
Mount SL, Cooper K. Tumours with divergent müllerian differentiation of the uterine corpus. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cdip.2005.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
64
|
Ohta Y, Suzuki T, Shiokawa A, Ota H. A case of uterine adenomyoma with bizarre smooth muscle cells mimicking leiomyosarcoma. Diagn Cytopathol 2005; 32:288-91. [PMID: 15830358 DOI: 10.1002/dc.20226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a case of adenomyoma of the uterus that was cytologically difficult to distinguish from leiomyosarcoma. Examination of a uterine cervical smear revealed numerous spindle cells that were present in cell clusters or as isolated cells. These cells contained nuclei that were oval-shaped/elongated with nucleoli and delicate wispy cytoplasm. Large and bizarre nuclei were also identified. Based on these cytological findings leiomyosarcoma was considered: however, this diagnosis remained uncertain because of the absence of mitosis and/or necrotic substance. Histologically, we recognized leiomyomatous smooth muscle cells growing in a solid pattern and intermingled with endometrial-type glands. Moreover, bizarre smooth muscle cells were observed in the surface layer of the tumor. These observations suggest that for a diagnosis of uterine leiomyosarcoma the presence of mitosis and/or necrosis is important in addition to nuclear atypia.
Collapse
Affiliation(s)
- Yoshiki Ohta
- Department of Pathology, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
| | | | | | | |
Collapse
|
65
|
Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls. Radiographics 2005; 25:21-40. [PMID: 15653584 DOI: 10.1148/rg.251045060] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adenomyosis is a nonneoplastic condition, characterized by benign invasion of ectopic endometrium into the myometrium with hyperplasia of adjacent smooth muscle. The common symptoms include dysmenorrhea, menorrhagia, and abnormal uterine bleeding, but these do not allow diagnosis. Therefore, imaging plays an important role because establishment of the correct preoperative diagnosis is critical to avoid unnecessary intervention. Magnetic resonance (MR) imaging is a highly accurate noninvasive modality for diagnosis of adenomyosis, differentiation of adenomyosis from other gynecologic disorders, and planning of appropriate treatment. Although the typical MR imaging findings are well established, adenomyosis actually varies widely in terms of histopathologic features (adenomyosis with sparse glands), growth patterns (polypoid adenomyoma, adenomyotic cyst, and miniature uterus), responses to hormonal activity (tamoxifen, decidual changes), and responses to treatment (gonadotropin-releasing hormone agonist). The MR imaging findings of adenomyosis occasionally mimic those of uterine malignancy or ovarian cancer. Furthermore, malignancy occasionally develops in otherwise benign adenomyosis. Pitfalls in diagnosis of adenomyosis include myometrial contractions, leiomyoma, adenomatoid tumor, metastases, endometrial carcinoma, and endometrial stromal sarcoma. Knowledge of the various appearances of adenomyosis and the possible pitfalls in differential diagnosis help guide the determination of appropriate treatment options.
Collapse
Affiliation(s)
- Ken Tamai
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
| | | | | | | | | | | |
Collapse
|
66
|
Lee EJ, Han JH, Ryu HS. Polypoid adenomyomas: sonohysterographic and color Doppler findings with histopathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1421-1431. [PMID: 15498906 DOI: 10.7863/jum.2004.23.11.1421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This study was undertaken to describe the sonographic features of polypoid adenomyomas of the uterus and to determine the diagnostic role of sonohysterography and color Doppler sonography in the evaluation of these lesions. METHODS The sonographic findings for 46 histologically proved cases of polypoid adenomyomas of the uterus, accumulated over 10 years, were reviewed retrospectively. The pathologic diagnoses included typical polypoid adenomyoma (n = 36), atypical polypoid adenomyoma (n = 7), and low-grade adenosarcoma arising in polypoid adenomyoma (n = 3). RESULTS Of 46 total uterine tumors, 31 were in the corpus, 12 were in the fundus, and 3 were in the isthmus. The mean tumor size was 3.5 cm (range, 0.5-9 cm). The tumors were polypoid in 30 cases, pedunculated in 11 cases, and sessile in the remaining 5 cases. Of the pedunculated tumors, 5 protruded into the endocervical canal and 2 had prolapsed into the vagina. Three distinct sonographic patterns were identified with respect to the presence of cystic areas: a solid mass (pattern 1) in 12 cases, a solid mass with cystic areas (pattern 2) in 32 cases, and a predominantly cystic mass (pattern 3) in 2 cases. The characteristic sonographic features of polypoid adenomyomas included heterogeneous or homogeneous isoechogenicity relative to the myometrium, a smooth surface, a poorly defined margin with the underlying myometrium, hemorrhagic foci, posterior shadowing, a single vascular pedicle entering the mass, and associated adenomyosis in the myometrium. CONCLUSIONS Knowledge of the sonographic appearance of polypoid adenomyomas may facilitate diagnosis and may help distinguish these tumors from other polypoid uterine tumors.
Collapse
Affiliation(s)
- Eun Ju Lee
- Department of Radiology, Ajou University Medical Center, San 5, Wonchon-dong, Yeongtong-gu, Suwon 443-721, South Korea.
| | | | | |
Collapse
|
67
|
Abstract
Uterine prolapse is a benign and common condition, especially in older women. In this study, we investigated the frequency and implications of incidental findings in uteri removed for prolapse. We found a high frequency of incidental findings that was greater than previously reported and a correlation between the occurrence of leiomyomata and adenomyosis. As long as all grossly visible lesions are sampled, two routine sections were found to be sufficient to identify all significant lesions.
Collapse
Affiliation(s)
- Hong Yin
- Department of Pathology, New York University School of Medicine, New York, NY 10016, USA
| | | |
Collapse
|
68
|
Abstract
Based on a retrospective analysis of 32 patients with polypoid adenomyomas of the uterus, the authors have identified 3 sonographic patterns: solid (pattern 1, 8 cases), solid with cystic areas (pattern 2, 22 cases), and predominantly cystic (pattern 3, 2 cases). Sonographic features include a heterogeneously isoechoic, polypoid, or pedunculated endometrial mass, with an ill-defined margin, hemorrhagic foci, posterior shadowing, and associated adenomyosis in the myometrium. Knowledge of these sonographic appearances may facilitate the diagnosis of polypoid adenomyoma and help differentiate it from other polypoid uterine tumors.
Collapse
Affiliation(s)
- Eun Ju Lee
- Associate Professor, Department of Radiology, Ajou University, School of Medicine, Suwon, South Korea.
| | | | | |
Collapse
|
69
|
Jha RC, Takahama J, Imaoka I, Korangy SJ, Spies JB, Cooper C, Ascher SM. Adenomyosis: MRI of the uterus treated with uterine artery embolization. AJR Am J Roentgenol 2003; 181:851-6. [PMID: 12933493 DOI: 10.2214/ajr.181.3.1810851] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the MRI features seen after uterine artery embolization and to evaluate the clinical response in patients with adenomyosis. MATERIALS AND METHODS Thirty women with adenomyosis underwent uterine artery embolization and follow-up MRI for 1 year. Of the 30, 27 patients were diagnosed with uterine fibroids and adenomyosis on the basis of MRI before uterine artery embolization. In six of the 27 patients, the dominant disease was adenomyosis. Three of the 30 patients had adenomyosis alone. The distribution, thickness, and enhancement of adenomyosis were analyzed in each patient. Patients completed a symptom questionnaire. RESULTS After uterine artery embolization, the junctional zone-myometrial ratio did not change significantly. There were regions of devascularization of adenomyosis on contrast-enhanced images in 12 patients, all with a junctional zone thickness before uterine artery embolization of more than 20 mm (mean thickness, 39.2 mm). Eleven of the 12 patients had focal or asymmetric distribution patterns of adenomyosis. All three patients with pure adenomyosis and all six patients with dominant adenomyosis reported an improvement in symptoms. CONCLUSION In patients treated with uterine artery embolization, MRI shows changes in areas of adenomyosis with a decrease in junctional zone vascularity in patients with thickening of the junctional zone greater than 20 mm. Devascularization may be related to the distribution of adenomyosis. The presence of adenomyosis should not be used as a contraindication to uterine artery embolization because most patients show clinical improvement after undergoing this procedure.
Collapse
Affiliation(s)
- Reena C Jha
- Department of Radiology, Georgetown University Medical Center, 3800 Reservoir Rd. N.W., Washington, DC 20007, USA
| | | | | | | | | | | | | |
Collapse
|
70
|
Connors AM, deSouza NM, McIndoe GA. Adenomyoma mimicking an aggressive uterine neoplasm on MRI. Br J Radiol 2003; 76:66-8. [PMID: 12595328 DOI: 10.1259/bjr/19147576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This case report concerns a nulliparous female with prolonged vaginal bleeding, where MRI demonstrated a mass with an aggressive, tumour like appearance involving the posterior aspect of the uterus. Histological examination confirmed that this was an adenomyoma. The unusual imaging appearance of this lesion and its differential diagnosis are discussed. Adenomyoma should be considered in the differential diagnosis of aggressive-appearing uterine masses.
Collapse
Affiliation(s)
- A M Connors
- Department of Gynaecology, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | | |
Collapse
|
71
|
Clement PB, Young RH. Endometrioid carcinoma of the uterine corpus: a review of its pathology with emphasis on recent advances and problematic aspects. Adv Anat Pathol 2002; 9:145-84. [PMID: 11981113 DOI: 10.1097/00125480-200205000-00001] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review considers the pathologic features of endometrioid carcinoma of the uterine corpus, which accounts for approximately 80% of endometrial adenocarcinomas, with an emphasis on its histologic features, recent advances, and problematic aspects. In addition to typical endometrioid carcinoma, the variants of endometrioid carcinoma covered include secretory carcinoma, villoglandular endometrioid carcinoma, endometrioid carcinoma with small nonvillous papillae, endometrioid carcinomas with microglandular and sertoliform patterns, and endometrioid carcinomas with metaplastic changes. These changes include a variety of different appearances of squamous epithelia (ranging from mature and keratinizing to immature with only subtle evidence of a squamous nature), clear cells, surface changes resembling syncytial metaplasia or microglandular hyperplasia, ciliated cells, oxyphilic cells, and spindled epithelial cells (sarcomatoid carcinoma). The last is one of several variants that may cause a biphasic appearance, all of which should be distinguished from the malignant müllerian mixed tumor. Rare findings in endometrioid carcinomas include hyalinization, psammoma bodies, and foci of stromal metaplasia such as osteoid. Unusual growth patterns of endometrioid carcinomas include involvement of adenomyosis, the "diffusely" infiltrating pattern of myoinvasion, and a previously unemphasized pattern of myoinvasion with "pinched off" glands that may be cystic or have a pseudovascular appearance, often with a myxoid stromal reaction. Other aspects of endometrioid carcinoma discussed are its immunoprofile, grading, cervical involvement (including a hitherto undescribed "burrowing" pattern of extension within the cervix that can result in underdiagnosis of stage IIB disease), carcinoma arising in the lower uterine segment, carcinoma arising in polyps and adenomyomas, carcinoma in young women, tamoxifen-related carcinoma, associated ovarian endometrioid carcinoma, and peritoneal keratin granulomas. Finally, the differential diagnosis of endometrioid carcinoma is briefly considered with a section on benign mimics, including curettage-related changes, menstrual changes, adenomyosis-related problems, metaplastic changes, atypical polypoid adenomyoma, radiation atypia, and papillary proliferations, and a section on metastatic colonic carcinoma.
Collapse
Affiliation(s)
- Philip B Clement
- Department of Pathology, Vancouver General Hospital and Health Sciences Center and the University of British Columbia, Canada
| | | |
Collapse
|