{"paper_id":"37124c4c-fc45-49b1-9c9f-354d2208cf85","body_text":"Submit Manuscript | http://medcraveonline.com\nCase summary\nA 48 years, Para3 Living3 perimenopausal women with regular \nmenstrual cycles underwent surgery for 3rd degree cervical descent \nand minimal cystocele and rectocele. Internal examination showed \nuterus of around eight weeks size, anteverted, mobile with bilateral \nfornices free. During her stay in hospital, all pre-operative work \nup done was within normal limits. Cervical smear was reported \ninflammatory. She had vaginal hysterectomy with anterior and \nposterior colpo-perineorrhaphy. Intra - operative findings showed \nuterus of 8 weeks size with multiple small (1*1cm) vesicular lesions \npresent all over serosal surface of the uterus (Figure 1 & 2).\nFigure 1 Vesicular lesions present all over serosal surface of the uterus.\nFigure 2  Vesicular lesions present all over serosal surface of the uterus.\nSpecimen sent for frozen section to rule out any malignant \npathology, which showed cystic spaces lined by benign cuboidal \nto columnar epithelial cells. No cyto-architectural atypia, mitosis \nor necrosis noted. Bilateral fallopian tubes & ovaries were \nnormal. A small polyp was present in the endometrial cavity. Final \nhistopathology report came as chronic cervicitis, adenomyosis of \nthe uterus with proliferative endometrium. Multiple sections taken \nfrom serosal aspect of the uterus were showing features suggestive of \nadenomatoid tumor. She otherwise had an uneventful recovery with \nan early discharge.\nObstet Gynecol Int J. 2017;7(1):204‒206. 204\n©2017 Verma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestrited use, distribution, and build upon your work non-commercially.\nAdenomatoid tumor of the uterus: an incidental \nfinding\nVolume 7 Issue 1 - 2017\nShailja Verma,1 Poonam Sachdeva2\n1Senior Resident OBGYN, LokNayak Hospital, India\n2Consultant OBGYN, LokNayak Hospital, India\nCorrespondence: Shailja Verma, Flat no.257, Great India \nAptt, Sector 6/15, Dwarka, New Delhi – 110075, India, T el 91-\n9811734193; +91-01125080453, Email \nReceived: October 26, 2016 | Published: May 17, 2017\nAbstract\nAn incidental finding of adenomatoid tumor was diagnosed in a hysterectomy specimen of \na postmenopausal women who underwent surgery for cervical descent. In intra – operative \nfindings multiple small vesicular lesions were seen over the uterine serosal surface. On \na detailed review of literature we found that it is predominantly a benign tumor with \nhistiogenesis of mesothelioma. Hence, no aggressive post-operative follow-up is required \nin these patients.\nObstetrics & Gynecology International Journal\nCase Report\n Open Access\n\n\nAdenomatoid tumor of the uterus: an incidental finding\n205\nCopyright:\n©2017 Verma et al.\nCitation: Verma S, Sachdeva P . Adenomatoid tumor of the uterus: an incidental finding. Obstet Gynecol Int J. 2017;7(1):204‒206. \nDOI: 10.15406/ogij.2017.07.00235\nDiscussion\nThe term adenomatoid tumor was first proposed by Golden and Ash \nin 1945.1 They are relatively rare benign neoplasms that usually arise \nin the genital tract. 2 The tumor is most frequently observed in male \ngenitalia, commonly, the epididymis. 3 It also appears in the female \ngenitalia of which fallopian tubes are the most common site, followed \nby the uterus and ovaries.2 The posterior surface of uterus, especially \nin the cornua, it has more predilection. They are mostly subserosal \nor situated in the outermost zone of the myometrium. Histiogenesis \nof adenomatoid tumors is controversial; mesonephric, mullerian, \nendothelial and mesothelial origins have been suggested. Previous \nstudies based on transmission electron microscopy, scanning electron \nmicroscopy and immunohistology support more of a mesothelial \norigin.2-4 Hence, they are a type of benign mesotheliomas.\nIncidence of adnomatoid tumors in the uterus in one series has been \nreported to be 1.2%.5 However, the true incidence is probably greater \nbecause these tumors frequently go unsampled as a result of their small \nsize and gross appearance, which is similar to that of leiomyoma. 3,4 \nMost large adenomatoid tumors are located subserosally in posterior \nwall of fundus or near the cornua.4,6 Most of the adenomatoid tumors \nof uterus are solitary, asymptomatic tumors that are incidentally \ndiscovered in hysterectomy specimens. 7 Adenomatoid tumors of the \nuterus typically occur in women of reproductive age. The majority \nof lesions are solitary, small and subserosal, with a median size of \n2cm (0.5 to 4cm), and usually well circumscribed. Their size is mostly \nwithin 5 mm of the uterine serosal surface.\nSeveral histologic types of adenomatoid tumors are found. Quigley \nand Hart described four types: adenoid, angomatoid, solid and cystic.7 \nThe most frequent types are the adenoid and the angiomatoid. The \ncystic type is the least common type and is very rare but has been \nreported in the pathology literature in several case reports. 3,4,6]. \nCombinations of two or more patterns occurred in all tumors, but one \nmajor type prevails commonly.\nMicroscopically, they present with four distinctive histological \ntypes, immunohistochemically given positive staining for keratin \nand for the mesothelial marker. They are characterized by a \nproliferation of flattened-to polygonal cells, showing frequent \nvacuolization arranged in gland like cystic spaces, tubules and cords \ninterspersed between the muscle fibres of the myometrium. Due to \nthe frequent predominanace of smooth muscle in these tumors, the \ninitial impression is frequently made, a variant of leiomyoma. It is \ndoubted whether the muscle is actually a neoplastic component of \nthe adenomatoid tumor. It is believed to be a reactive hyperplasia \nof indigenous myometrial smooth muscle, which encompasses the \nadenomatoid tumor in a fashion analogous to adenomyosis of uterus. \nThis contention is supported by the absence of smooth muscle bundles \nin adenomatoid tumors occurring in sites where muscle is not normally \npresent, like ovary and mesentry. Though the gland like spaces \nresemble the clear spaces seen in adipose deposits of lipoleiomyoma, \nbut closer evaluation rules out one. Also, the absence of associated \nendometrial- type stroma or typical columnar endometrial epithelial \ncells differentiated it from adenomyoma. These tumors can mimic \nhemangioma or lymphangioma on histopathology, but the absence \nof material within the lumen, as well as the absent expression on \nendothelial markers like CD 34 on immunohistochemistry, will argue \nagainst this diagnosis. The immunohistochemical results support the \ntheories of histiogenesis of the adenomatoid tumor as a type of benign \nmesothelioma.8\nD2-40 is the most useful marker for adenomatoid tumors in the \nfemale genital tract because of its combined high sensitivity and \nlimited background staining. 9  But as this antigen is also used to \nidentify the lining of lymphatic vessels, care must be taken not to \nrely on this stain completely to differentiate the two. 10 These tumor \ncells are strongly positive for cytokeratin, vimentin, calretinin and \nHMBE-1 (anti-human mesothelioma antibody), but do not express \nEMA, CEA.1,11,12 One study found estrogen and progesterone receptor \nexpression is weak and focal and none stained for the androgen \nreceptor.13\nMost significantly, the differential diagnosis for adenomatoid \ntumor may also include infiltrating carcinoma. Cytologic features of \nthe lesion, particularly lack of significant nuclear atypia or mitotic \nactivity and identification of typical features as described above \nshould assist in the recognition of this lesion. Also, Calretinin, \nwhich is strongly expressed in adenomatoid tumor, is not expressed \nin most of the carcinomas which might involve the myometrium, \nalthough it must be remembered that it can be expressed in certain \novarian tumors, in which case additional stains may be required if the \nhistology features are not clear cut. 10,14,15 Adenomatoid tumors with \na diffuse infiltrative growth pattern have to be distinguished from \nmalignant lesions such as metastatic signet ring cell adenocarcinoma, \nepithelioid hemangioendothelioma, along with germ cell tumor or sex \ncord stromal tumors as told above. 11 But unlike malignancy they do \nnot require aggressive follow up.\nAdenomatoid tumors may arise from inclusions of mesothelioma \nincorporated into subserosal connective tissue or myometrium. \nPatients who develop adenomatoid tumors may have a labile \nperitoneum with a propensity to form a variety of proliferative lesions \nof mesothelial cells. Some adenomatoid tumors conceivably could \narise directly from uterine mesenchymal cells, which have retained a \npotential to differentiate into mesothelial cells.16\nThis tumor though benign still its incidental occurrence keeps \ngynecologists inquisitive till histopathology confirmation.\nAcknowledgments\nNone.\nConflicts of interest\nNone.\nReferences\n1. Hong R, Choi DY , Choi SJ, et al. Multicentric infarcted \nleiomyoadenomatoid tumor: a case report. Int J Clin Exo Pathol . \n2009;2(1):99–103.\n2. Mitsumori A, Morimoto M, Matsubara S, et al. MR appearance \nof adenomatoid tumor of the uterus. J Comput Assist Tomogr . \n2000;24(4):610–613.\n3. Livingston EG, Guis MS, Pearl ML, et al. Diffuse atenomatoid tumor \nof the uterus with a serosal papillary cystic component. Int J Gynecol \nPathol. 1992;11(4):288–292.\n4. Rosa GD, Boscaino A, Terracciano LM, et al. Giant adenomatoid tumors \nof the uterus. Int J Gynecol Pathol. 1992;11(2):156–160.\n5. Tiltman AJ. Adenomatoid tumors of the uterus. Histopathology. \n1980;4:437–43\n6. Palacios J, Manrique AS, Villaespesa AR, et al. Cystic adenomatoid \ntumor of the uterus. Int J Gynecol Pathol . 1991;10(3):296–\n301.                                                                                                                                      \n\nAdenomatoid tumor of the uterus: an incidental finding\n206\nCopyright:\n©2017 Verma et al.\nCitation: Verma S, Sachdeva P . Adenomatoid tumor of the uterus: an incidental finding. Obstet Gynecol Int J. 2017;7(1):204‒206. \nDOI: 10.15406/ogij.2017.07.00235\n7. Quigley JC, Hart WR. Adenomatoid tumor of the uterus. Am J Clin \nPathol. 1981;76:627–635.\n8. Buzzia A, Pezzica E, Crescini C. An Adenomatoid tumor of the uterus. \nMinerva Ginecol. 1994;46(6):359–364.\n9. Ankur R Sangoi, Jesse K McKenny, Erich J Schwartz, et al. Adeomatoid \ntumors of the female and male genital tracts: a clinicopathological \nand immunohistochemical study of 4 cases. Modern Pathology . \n2009;22(9):1228–1235.\n10. Alkatout I, Bojahr B, Dittmann L, et al. Precarious preoperative \ndiagnostics and hints for the laparoscopic excision of uterine \nadenomatoid tumors: two exemplary cases and literature review. Fert \nSter. 2011;95(3):1119e5–1119e8.\n11. Bolat F, Kocer E, Bal N, et al. Adenomatoid tumor of the female genital \ntract: Report of three cases. Turk J Pathol. 2007;23(2):98–102.\n12. Amre R, Constantino J, Lu S, et al. Pathologic quiz case: a 52 year old \nwoman with a uterine mass. Leiomyo–adenomatoid tumor of the uterus. \nArch Pathol Lab Med. 2005;129(3):e77–e78.\n13. Wachter DL, Wunch PH, Hartmann A, et al. Adenomatoid tumors of \nthe female and male genital tract. A Comparitive clinicopatholica and \nimmunohistochemical analysis of 47 cases emphasizing their site \nspecific morphologic diversity. Virchows Arch. 2011; 458(5): 593–602.\n14. Amérigo J, Amérigo–Góngora M, Giménez–Pizarro A, et al. Leiomyo–\nadenomatoid tumor of the uterus: a distinct morphological entity? Arch \nGynecol Obstet. 2010; 282(4):451–454.\n15. Erra S, Pastormerlo M, Gregori G, A case of leiomyoadenomatoid tumor \nof the uterine serosa: speculations about differential diagnosis. BMJ \nCase Rep. 2009\n16. Mazur MT, Kraus FT) Histiogenesis of morphologic variations in \ntumors of the uterine wall. Am J Surg Pathol. 1980;4(1):59–74.\n17. Wachter DL, Wunch PH, Hartmann A, Adenomatoid tumors of the \nfemale and male genital tract. A Comparitive clinicopatholica and \nimmunohistochemical analysis of 47 cases emphasizing their site \nspecific morphologic diversity. Virchows Arch. 2011;458(5):593–602.\n18. Alkatout I, Bojahr B, Dittmann L, Warneke V , et al. Precarious \npreoperative diagnostics and hints for the laparoscopic excision of \nuterine adenomatoid tumors: two exemplary cases and literature review. \nFert Ster. 2011;95(3):1119e5–1119e8.\n19. Amérigo J, Amérigo–Góngora M, Giménez–Pizarro A, et al. Leiomyo–\nadenomatoid tumor of the uterus: a distinct morphological entity? Arch \nGynecol Obstet. 2010;282(4):451–454.\n20. Erra S, Pastormerlo M, Gregori G, A case of leiomyoadenomatoid tumor \nof the uterine serosa: speculations about differential diagnosis.  BMJ \nCase Rep. 2009\n21. Bolat F, Kocer E, Bal N, Adenomatoid tumor of the female genital tract: \nReport of three cases. Turk J Pathol. 2007;23(2):98–102.\n22. Amre R, Constantino J, Lu S, et al. Pathologic quiz case: a 52 year old \nwoman with a uterine mass. Leiomyo–adenomatoid tumor of the uterus. \nArch Pathol Lab Med. 2005;129(3): e77–e78.\n23. Mazur MT, Kraus FT. Histiogenesis of morphologic variations in tumors \nof the uterine wall. Am J Surg Pathol. 1980;4(1):59–74.","source_license":"CC0","license_restricted":false}