Adenomatoid tumors are rare benign neoplasms. In women, the adenomatoid tumor usually originates in the fallopian tube. Its presence in the uterus is relatively rare although over 75 cases have been reported'. We report one such case.
A 46 year old woman attended the outdoor service with complaints of excessive, frequent and painful periods, and excessive white vaginal discharge, both since three years. She was asymptomatic three years ago . Her menstrual cycles became shortened to 15 days with excessive flow and pain lasting 8 days. Her LMP was 12 days back. She had increased white, mucoid, vaginal discharge, with no foul smell or blood in it. Her past menstrual history was regular with average flow. She had four FIND, last being eight years ago.
Onexaminationher vital parameters were stable. All blood investigations were within normal limits. On speculum examination cervical erosion was present and vaginal mucosa was normal. On vaginal examination cervix was pointing backwards, uterus was anteverted, anteflexed, normal size, firm and mobile, and the fornices were free. Pap smear revealed no abnormality. Fractional curettage was done. Histopathology of curettings showed proliferative phase. Ultrasonography reported fibroid in the uterus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done without difficulty. Patientstood the operation well.
Histopathology of the specimen- Uterus measured 12x7x6 ems,On serialsectioning, uterine canal wasfound patent. Maximum thickness of myometrium was 3 ems. A single grayish yellow area of 0.8 cms was seen. The tubes measured 6 ems each. The ovaries measured 3x2x3 ems each. Cervix, both tubes and ovaries were normal. Microscopy revealed adenoinatoid mesothelioma showing ramifying tubules like spaces lined by benign cuboidal cells within fibrous tissue and smooth muscle cells. Few of these spaces were dilated. No cellular atypia or mitotic activity was seen (Fig.l). Endometrium was in proliferative phase. Cervix had chronic cervicitis. Tubes and ovaries were unremarkable.
Adenomatoid tumors arising in the uterus are uncommon.
Characteristically, they are small nodular lesions in the
subserosa or outer wall of myometrium. They can be
mistaken histologically for leiomyomas or nodules of
adenomyosis, and most importantly for angiomas and
angiomyomas (angiomatoid and cystic types), and for
metastatic carcinoma (the solid and adenoid types). They
tend to be less well demarcated than leiomyomas and tan
gray in colour. Ultrastructural and histochemical studies
indicate them to be a type of benign mesothelioma. The
proliferation ofsmooth muscles which accompanies some
tumors was regarded as a non-neoplastic hyperplasia of
myometrium. Four distinctive histological types (adenoid,
angiomatoid,solid and cystic) are identified.The solid and
adenoid types may be mistaken for a metastatic carcinoma.
The angiomatoid and cystic types may be misinterpreted
as angiomas or angiornyornas. An awareness of the
characteristic histologic patterns of adenomatoid tumors
and their transitional forms coupled with an appreciation
of their gross appearance and topographic location in the
uterus will greatly aid proper diagnosis. Because
adenornatoid tumors have been more widely stated as
lesions of the fallopian tube than of the uterus, problemsin
the diagnosis are likely to occur when they are incidentally
discovered in a hysterectomy specimen. They should be
managed as benign tumors.
