Adenomyosis With Sparse Glands:A Potential Mimic of Low-Grade Endometrial Stromal Sarcoma
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This paper describes seven cases of adenomyosis with sparse glands that presented diagnostic challenges, detailing features that differentiate it from low-grade endometrial stromal sarcoma.
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Abstract
Most cases of adenomyosis are easily recognized by the presence of intramyometrial aggregates of endometrial glands and endometrial stromal cells surrounded by hypertrophic smooth muscle. The authors report seven cases of adenomyosis with sparse glands, which was a finding that initially caused difficulties in diagnosis and raised the question of low-grade endometrial stromal sarcoma (LGESS). The patients' ages ranged from 51 to 81 years. All were postmenopausal. Each had undergone hysterectomy for a variety of reasons unrelated to the adenomyosis. Microscopic examination of the uteri disclosed multiple intramural nests of adenomyotic endometrial stromal cells without endometrial glands, ranging from 0.5 mm to 8.0 mm in maximum dimension. The percentage of adenomyotic foci without glands in each case ranged from 40% to 94%. Two cases also had foci of intravascular intrusion by the gland-poor adenomyotic stroma. The most useful features for differentiating adenomyosis with sparse glands from LGESS include: (1) its occurrence as an incidental finding in uteri removed for other reasons; (2) the microscopic size of the adenomyotic foci without grossly evident tumor nodules; (3) a distinctive concentric zonal organization of the gland-poor stromal aggregates, with less cellular pale centers surrounded by a thin rim of stromal or smooth muscle cells with increased cellularity, often with a thicker, but less well-defined, peripheral zone of hypertrophic myometrial smooth muscle; (4) the atrophic appearance of the stromal cells and absence of nuclear atypia and mitotic figures; (5) an absence of sclerotic areas, foam cells, sex cordlike structures, hemangiopericytoma-like vascular pattern, prominent vascular invasion and extrauterine extension commonly found in LGESS; (6) the presence of typical adenomyosis with glands elsewhere in the myometrium; and (7) the postmenopausal age of the patient.
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Cited by (23)
- Adenomiosis: diagnóstico 2023
- Proliferative characteristics of eutopic and ectopic endometrium in adenomyosis using AgNOR technology 2023
- Endometrial Polyp-Like Lesions Arising From Adenomyosis: Report of 5 Cases 2023
- Ectopic Endometrium: The Pathologist’s Perspective 2021
- Endométriose et adénomyose 2021
- Adenomyosis presenting as a molar pregnancy: A case report 2020
- Pathology and Pathogenesis of Adenomyosis 2020
- Diagnosing adenomyosis: an integrated clinical and imaging approach 2020
- Histopathological Analysis of Endometrial Changes in Association with Myometrial Lesions of Hysterectomy Specimens 2019
- The Pathophysiology of Adenomyosis 2015
- Infiltrating Adenomyosis of the Cervix With Features of a Low-grade Stromal Sarcoma 2014
- Diagnóstico de la adenomiosis 2014
- The pathophysiology of uterine adenomyosis: an update 2012
- Does the presence of adenomyosis and lymphovascular space invasion affect lymph node status in patients with endometrioid adenocarcinoma of the endometrium? 2012
- Adenomyosis with extensive glandular proliferation simulating infiltrating malignancy on magnetic resonance imaging 2011
- Vascular Involvement in Adenomyosis: Report of a Large Series of a Common Phenomenon With Observations on the Pathogenesis of Adenomyosis 2010
- Endometrial stromal sarcomas with extensive endometrioid glandular differentiation: report of a series with emphasis on the potential for misdiagnosis and discussion of the differential diagnosis 2009
- Mesenchymal uterine tumors, other than pure smooth muscle neoplasms, and adenomyosis 2009
- Endometrial Carcinoma 2009
- MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls 2005
- Endometrial stromal sarcoma resembling adenomyosis and menstrual-phase endometrium 2004
- 10.1016/s0246-1064(21)43899-5 2000
- 10.1016/s0246-1064(13)59690-3 2000
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