P34.08: Leiomyoma and adenomyosis lesions appearing malignant in young patient

Adenomyosis still represents an enigmatic feature in gynecology. It is diagnosed mainly in women around 45 yrs old, multiparous, who might complain for abdominal pain of various degrees and / or various types of menstruation disturbances. Very often it coexists with leiomyomas. We report a case of a young woman, 19 yrs old, who arrived at the hospital complaining for menometrorrhagia during the last 6 months. At the gynecological examination no specific problem has been observed except a slight sensitivity. The hematologic pattern showed no pathology. During ultrasound examination, we observed a lesion of 53 × 45 × 50 mm dimensions, located on the anterior wall of the uterus (dimensions of the uterus: 71 × 58 × 66 mm). Said lesion showed heterogeneous echogenicity, with cystic and solid areas, extending in the endometrium but confined in the body of the uterus. Doppler analysis revealed increased vascularity (color Doppler 4) with bugged vessels and ramifications features like tree branches. Infusion of saline in the endometrial cavity, which was performed slightly, failed to distend it. Diagnosis was probably sarcoma of uterus. MRI confirmed the ultrasound results. The excision of the lesion in the operation theater and the initial histological analysis showed sarcoma. Further evaluation of the preparation with H and E sections and immunohistochemistry showed a positive reaction for SM-Myosin and h-Caldesmon, both being good markers for smooth muscle differentiation, thus placing finally the diagnosis at benign cellular leiomyoma of the uterus and coexistence of adenomyosis. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.