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This letter discusses the unknown incidence of uterine adenomatoid tumors, suggesting geographic pathology, lower parity, reduced inflammatory diseases, and diffuse, inapparent tumors may contribute to its underestimation.
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by qwen3.7-flash, 2026-08-25
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This correspondence addresses the uncertainty surrounding the true incidence of adenomatoid tumors of the uterus, contrasting recent findings with historical data from South Africa. The authors report a significantly lower incidence in their western Mediterranean cohort, attributing this disparity to demographic factors such as low parity and reduced rates of inflammatory diseases that may trigger these reactive lesions. They further note that diffuse tumor types often escape macroscopic detection, complicating accurate prevalence assessment. This paper is centrally about adenomyosis-related pathology, specifically focusing on the diagnostic challenges and epidemiological variations of adenomatoid tumors within the uterine tissue.
Abstract
To the Editor: We thank Dr. Tiltman for his interest in our paper, which reported the largest series yet on adenomatoid tumors of the uterus (1). We also appreciate his agreement with our statement that the true incidence of adenomatoid tumors of the uterus is unknown. In our paper we were not able to extract reliable data as to their relative incidence because of the diverse origins of our material, although we were aware of his meticulous study of 1000 hysterectomy specimens performed in South Africa in the late 1970s (2). During the last two decades we have tried to test his hypothesis in our routine material, which is studied by the same observers using a similar macroscopic analysis. Our unreported incidence data were, however, drastically lower than those found in his study; indeed, it was a third of that reported by him. We believe that this difference is due to the variable geographic pathology of populations in each study. Our material comes principally from western Mediterranean countries in the European Union, where a socially homogeneous population of women nowadays has a very low parity as well as a low incidence of transmissible inflammatory diseases. This may be significant in the correspondingly low incidence of adenomatoid tumors of the uterus, because it is possible that they may have a reactive origin following birth trauma or uterine inflammation, as proposed in our study (1). Another factor complicating the assessment of incidence is that at least 15% of adenomatoid tumors of the uterus are of a diffuse type that are grossly inapparent and thus may escape detection by the pathologist. For all these reasons we believe that incidence of adenomatoid tumors of the uterus remains largely unknown. Francisco Nogales, M.D. Maria Alejandra Isaac, M.D. Luisanna Bosincu, M.D.
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To the Editor:
We thank Dr. Tiltman for his interest in our paper, which reported the largest series yet on adenomatoid tumors of the uterus (). We also appreciate his agreement with our statement that the true incidence of adenomatoid tumors of the uterus is unknown. In our paper we were not able to extract reliable data as to their relative incidence because of the diverse origins of our material, although we were aware of his meticulous study of 1000 hysterectomy specimens performed in South Africa in the late 1970s (). During the last two decades we have tried to test his hypothesis in our routine material, which is studied by the same observers using a similar macroscopic analysis. Our unreported incidence data were, however, drastically lower than those found in his study; indeed, it was a third of that reported by him. We believe that this difference is due to the variable geographic pathology of populations in each study. Our material comes principally from western Mediterranean countries in the European Union, where a socially homogeneous population of women nowadays has a very low parity as well as a low incidence of transmissible inflammatory diseases. This may be significant in the correspondingly low incidence of adenomatoid tumors of the uterus, because it is possible that they may have a reactive origin following birth trauma or uterine inflammation, as proposed in our study (). Another factor complicating the assessment of incidence is that at least 15% of adenomatoid tumors of the uterus are of a diffuse type that are grossly inapparent and thus may escape detection by the pathologist. For all these reasons we believe that incidence of adenomatoid tumors of the uterus remains largely unknown.
Francisco Nogales, M.D.Maria Alejandra Isaac, M.D.Luisanna Bosincu, M.D.References
- 1. Nogales FF, Isaac MA, Hardisson D, et al. Adenomatoid tumors of the uterus: an analysis of 60 cases. Int J Gynecol Pathol 2002; 21:34–40.
- 2. Tiltman AJ. Adenomatoid tumours of the uterus. Histopathology 1980; 4:437–43.
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