Extrauterine adenomyoma of the liver with a focally cellular smooth muscle component occurring in a patient with a history of myomectomy: case report and review of the literature

Extrauterine adenomyoma: A case report and systematic review of the literature

OBJECTIVE

To describe a case of extrauterine adenomyoma (EA) and review all the cases of EA in the literature.

METHODS

Pubmed/MEDLINE, Embase, and Google Scholar from 1807 to December 2022. All studies reporting the histologic diagnosis of an EA. We collected the following data: patient's age, size and location of adenomyoma, presence of endometriosis and adenomyosis, past gynecologic treatment, symptoms, diagnostic imaging, surgical intervention, alternative/adjuvant treatment, associated malignancy, and follow up.

RESULTS

Sixty-seven studies with 85 patients were included. Pain was the most frequent symptom (69.5%). Among diagnostic examinations, ultrasonography was used in 60 out of 81 reported cases, with several radiologic features described. EA was located inside the pelvis in 77.6% of patients. Adnexa were the most frequent site of the disease (24, 28.2%). History of endometriosis or adenomyosis was described in 35 patients (35, 41.2%). Uterine tissue morcellation was reported in 6 of the 85 patients (7.1%). Associated malignancy was detected in 9 out of 85 patients with available data (10.6%). There were two recurrences of disease.

CONCLUSION

Specific imaging features of EA are yet to be described in the literature. History of endometriosis and adenomyosis or uterine tissue morcellation may be suggestive of EA. Histologic examination can give a definitive diagnosis and exclude malignant transformation.

Extrauterine adenomyoma of the lesser omentum: A case report and review of the literature

RATIONALE

The extrauterine adenomyoma is rare and it is extremely rare outside the pelvic cavity. Herein, we reported the first case of a single extrauterine adenomyoma occurring in the lesser omentum.

PATIENTS CONCERNS

This case involved a 55-year-old woman who had undergone subtotal gastrectomy and omentectomy for gastric carcinoma. During postoperational pathological examination, 1 lymph node-like mass was coincidentally found in the lesser omentum. The patient had a history of hysterectomy for uterine leiomyoma 8 years ago.

DIAGNOSES

The resected 17 "lymph nodes" from the lesser omentum were routinely checked for possible metastasis of gastric carcinoma. One of lymph node-like mass was microscopically showed that it was composed of benign smooth muscle components, endometrial glands and stroma by HE staining. Therefore, adenomyoma was initially considered.

INTERVENTIONS

The lymph node-like mass was removed together with the lesser omentum during the subtotal gastrectomy and omentectomy for gastric carcinoma. No special intervention was performed for the adenomyoma.

OUTCOMES

Immunohistochemical staining confirmed that smooth muscle tissue was diffusely and strongly positive for Desmin, smooth muscle actin, estrogen receptor, and progesterone receptor, and negative for CD117, Dog-1, S100, and CD34. Endometrial glands and stroma were positive for estrogen receptor and progesterone receptor, and the endometrium interstitium was also positive for CD10. The final diagnosis of extrauterine adenomyoma occurring in the lesser omentum was established.

LESSONS

So far, to the best of our knowledge, total 53 cases of extrauterine adenomyoma have been reported in 45 English reports. The most common location for a single mass was pelvic cavity (37 cases), but rarely outside the pelvic cavity. This is the first case of a single extrauterine adenomyoma occurring in the lesser omentum.

Case Report: Benign Uterine Adenomyoma Metastasis in the Right Lung

Background

Pulmonary metastasis of benign uterine leiomyoma and uterine endometriosis has been reported; however, pulmonary benign metastasizing uterine adenomyoma has not been reported. Herein, we report the first case of pulmonary benign metastasizing uterine adenomyoma. It is very important to differentiate from pulmonary primary synovial sarcoma; histopathology and immunohistochemistry are very helpful, molecular pathology can be used if necessary.

Case Presentation

A female patient was admitted to the hospital because of pulmonary nodules. Lung computed tomography (CT) showed a nodular high density shadow in the upper lobe of the right lung, with a clear boundary and a diameter of approximately 1.2 cm. A contrast CT scan showed obvious enhancement, and no obvious lobulation or burr was found. Video-assisted thoracoscopic resection of the tumor was performed. The upper lobe nodules were completely removed. Postoperative pathological report confirmed the lesion as metastatic benign adenomyoma of the right upper lung.

Conclusion

The lung is the most common organ for malignant tumor metastasis, and a few benign tumors can also develop pulmonary metastasis. Pulmonary benign metastasizing adenomyoma is extremely rare, and the prognosis is very good after surgical resection. When pulmonary CT shows a solid high-density shadow, we should consider the possibility of a metastatic benign tumor.

Two Rare Entities in One Patient: Mucinous Tubular and Spindle Cell Carcinoma of the Kidney and Peritoneal Adenomyomas

Mucinous tubular and spindle cell carcinoma of the kidney is a rare subtype of renal cell carcinoma, that is believed to portend a favorable prognosis. Adenomyomas are benign tumors that typically arise from the myometrium. Extrauterine adenomyomas are extremely rare, with only a few cases reported in the literature. Here, we present an unusual case of a 46-year-old woman, with an incidentally detected bulky interpolar left kidney mass measuring 12 cm and multiple lobulated coalescent peritoneal nodules in the large epiploon suspicious for peritoneal carcinomatosis. A biopsy of the lesions revealed a mucinous tubular and spindle cell carcinoma of the kidney and extrauterine adenomyomas of the peritoneum. A left radical nephrectomy was performed and long-term hormone therapy with gonadotropin-releasing hormone agonists was prescribed. The purpose of this article is to focus on these two rare lesions, review the current literature, illustrate their key imaging findings along with pathologic correlation, as well as to discuss the differential diagnosis and clinical management.

A rare case of ovarian adenomyoma mimicking primary invasive ovarian cancer with a contralateral serous borderline ovarian tumor: A case report and review of the literature

Extrauterine adenomyoma is a rare type of benign tumor, characterized by nodular aggregate of smooth muscle, endometrial glands and endometrial stroma, arising outside the uterus. In this study we describe a case of primary ovarian adenomyoma associated with endometriotic cysts with contralateral serous borderline tumor in a 40-year-old woman and we highlight how preoperative exams could lead to the suspicious of invasive cancer. We provide a review of the literature, analyzing all cases of extrauterine adenomyoma published so far, classifying them on the basis of pathogenetic theories proposed, localization of the lesion, imaging modalities and treatment adopted.

Extrauterine Adenomyoma of the Liver Mimicking a Hepatic Adenoma: A Case Report

Extrauterine adenomyoma of the liver is extremely rare. Only a few cases have been reported, and these reports have focused mainly on histopathology. Herein, we report the specific imaging findings of extrauterine adenomyoma of the liver in a 43-year-old woman with epigastric pain, which was initially diagnosed as a hepatic adenoma. CT and MRI revealed a solid and cystic mass with hemorrhagic foci and weak persistent enhancement, located in the subcapsular region of the right hepatic lobe.

Extrauterine adenomyoma: a review of the literature

Adenomyosis is the presence of endometrial glands and stroma within the myometrium. The focal and localized form of adenomyosis is known as adenomyoma. It is rarely located outside the uterus which is termed as extrauterine adenomyoma. We describe three cases of extrauterine adenomyomas which were located in pararectal space, round ligament and ovary. These cases were treated by laparoscopic excision and diagnosis was confirmed by histopathological examination. A review of the literature identified 34 cases of extrauterine adenomyomas. The most common locations were pararectal space, ovary and broad ligament. Other pelvic locations included the round ligament, paraovarian, parametrial and pelvic wall. Extrapelvic adenomyomas were located in the liver, upper abdomen, inguinal scar, appendix and small bowel mesentery. The abdominopelvic pain was the most common clinical presentation of extrauterine adenomyoma. Various imaging modalities were used to identify extrauterine masses, but a definitive diagnosis could not be made preoperatively in any of the cases. Although rare, a possible diagnosis of adenomyoma must be contemplated while dealing with extrauterine masses. Surgical excision is the mainstay of treatment. Since malignancy has been reported in extrauterine adenomyomas, this possibility must be kept in mind while offering treatment.

Uterus-like Masses in a Rhesus Macaque (Macaca mulatta)

Endometriosis is a relatively common condition in women and some populations of adult female rhesus macaques. However, endometriosis with extensive smooth muscle proliferation, as occurs in endomyometrioma and uterus-like mass (ULM), is rare in women. This report describes a case of endometriosis with extensive smooth muscle metaplasia resembling multiple ULM in a 20-y-old female rhesus macaque. During a protocol-related procedure, a large, smooth, globoid, freely moveable mass was palpated in the midabdomen. Ultrasonography revealed a cystic structure from which dark brown fluid was aspirated. During exploratory laparotomy, an 8-cm spherical mass in the greater omentum and 3 additional masses (diameter, 2 to 5 cm) attached to the omentum were excised. Microscopic examination of the masses revealed numerous foci of ectopic endometrial glands and stroma frequently surrounded by bundles of smooth muscle and fibrous connective tissue. The gross and histologic lesions in this macaque bore many similarities to ULM in women. To our knowledge, this case represents the first report of endometriosis resembling a uteruslike mass in a NHP.

Extrauterine fibroids: a diagnostic challenge and a long-term battle

Extrauterine fibroids often present a diagnostic challenge due to the unusual locations they arise from. We present a series of rare extrauterine fibroids. In recent years, these fibroids have been associated with previous morcellated hysterectomies or myomectomies. Our series of six patients were found to have extrauterine fibroids (confirmed through histology) and underwent open hysterectomy and open or laparoscopic myomectomy. Four had undergone previous laparoscopic myomectomies while the other two had no previous intra-abdominal surgeries. Postsurgical occurrence may be caused by incomplete removal of morcellated fibroid tissue. Spontaneous occurrence can be associated with congenital Müllerian system defects. Extrapolating from this hypothesis, we recommend physicians to make sure that counselling for extrauterine seeding and dissemination of unexpected malignancy is undertaken in cases of minimally invasive surgeries where morcellation is expected. Long-term tumour surveillance is thus essential in such instances.

Extrapelvic endometriosis: a rare entity or an under diagnosed condition?

Endometriosis is a clinical entity characterized by the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. Endometriosis can be either endopelvic or extrapelvicdepending on the location of endometrial tissue implantation. Despite the rarity of extrapelvic endometriosis, several cases of endometriosis of the gastrointestinal tract, the urinarytract, the upper and lower respiratory system, the diaphragm, the pleura and the pericardium, as well as abdominal scars loci have been reported in the literature. There are several theories about the pathogenesis and the pathophysiology of endometriosis. Depending on the place of endometrial tissue implantation, endometriosis can be expressed with a wide variety of symptoms. The diagnosis of this entity is neither easy nor routine. Many diagnostic methods clinical and laboratory have been used, but none of them is the golden standard. The multipotent localization of endometriosis in combination with the wide range of its clinical expression should raise the clinical suspicion in every woman with periodic symptoms of extrapelvic organs. Finally, the therapeutic approach of this clinical entity is also correlated with the bulk of endometriosis and the locum that it is found. It varies from simple observation, to surgical treatment and treatment with medication as well as a combination of those.