Intravascular adenomyomatosis: expanding the morphologic spectrum of intravascular leiomyomatosis

Lynn Hirschowitz, Hirschowitz L, F. Mayall, Frederick G Mayall, Mayall FG, Raji Ganesan, Ganesan R, W. Glenn McCluggage, McCluggage WG
The American journal of surgical pathology · 2013 · vol. 37(9) , pp. 1395–1400 · doi:10.1097/pas.0b013e31828b2c99 · PMID:24076777 · W2328066591
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Five cases of intravenous adenomyomatosis, a variant of intravascular leiomyomatosis containing smooth muscle, glandular, and stromal elements, were identified in older women with associated adenomyosis and leiomyomas.

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Abstract

Intravascular leiomyomatosis (IVL) is characterized by the presence of smooth muscle in venous and lymphatic spaces within the myometrium. Although the intravascular component usually consists solely of typical smooth muscle or variants of smooth muscle differentiation, we report 5 cases in which the intravascular component also included endometrioid glandular and stromal elements. We propose the term "intravenous adenomyomatosis" to describe this unusual variant of IVL. The mean age of the patients in this series was 50.2 years, slightly older than that of patients with conventional IVL. In addition to intravenous adenomyomatosis, both adenomyosis and leiomyomas were identified in all of our cases, supporting the hypothesis that the intravascular smooth muscle component in IVL is derived from associated myometrial pathology rather than from vessel walls. In our series, intravenous adenomyomatosis had a similar benign clinical behavior to most cases of IVL with no metastatic or recurrent disease identified at follow-up in 4 cases for which follow-up information was available. The main differential diagnoses are adenomyosis with vascular involvement, low-grade endometrial stromal sarcoma (ESS), including ESS with smooth muscle and glandular differentiation, and adenosarcoma with lymphovascular invasion. The possibility of intravenous adenomyomatosis should be borne in mind when considering these diagnoses, particularly ESS and adenosarcoma, which have different implications for patient management and prognosis.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenosarcoma Leiomyomatosis Myometrium Sarcoma, Endometrial Stromal Uterine Neoplasms Veins Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenosarcoma Adenosarcoma Adenosarcoma Adenosarcoma Adenosarcoma Adult Adult Aged

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (14)

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