Adenocarcinoma arising in adenomyosis: report of an unusual case

Endometrial adenocarcinoma and adenomyosis are both common pathologic conditions that develop in the uterus.Adenocarcinoma arising from adenomyosis is rare but has been described, with similar alterations in the endometrium.Furthermore, there have been a few reports of adenocarcinoma developing in adenomyotic areas without endometrial involvement (1-11).We report a case of endometrial adenocarcinoma arising in a focus of adenomyosis localized in the outer half of the myometrium, with no involvement of the surface of the endometrium. Case reportOFBGB, a 62-year-old, nulliparous, white woman, presented with postmenopausal bleeding for 2 years with no other complaints.Menarche at the age of 11 years.Menopause at the age of 53 years.She had been on antidiabetic and antihypertensive drugs for several years.She was an obese woman with a body mass index of 34.2.Dilatation and curettage (D & C) was performed, revealing endometrial hyperplasia with atypia.The serum level of CA-125 was within normal limits.Magnetic resonance imaging of the pelvis showed four uterine nodules, with the biggest being 2 cm in diameter, hypodense at TI and T2, most probably corresponding to fibroids.In the myometrium there was a nodule with an intermediate sign at T1 and T2 that pushed inwards the adjacent endometrium.Inside this nodule there were two punctate images with an identical sign to that of the endometrium.This nodule may represent an area of adenomyosis (Fig. 1).The nodule was well circumscribed and localized in the inner third of the myometrium.The endometrium had normal thickness throughout the cavity.The cervix was normal.Abnormal lymph nodes were not identified.The patient underwent a total abdominal hysterectomy with bilateral adnexectomy.