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Case of the Week #232

7 February 2012 - Case of the Week #232

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Saturday, May 19, 2012
The Townsend Hotel
Birmingham, Michigan (USA)

Current Concepts in
GYN Oncology and Pathology


Sponsored by Karmanos Cancer Institute, Henry Ford Health System,
Wayne State University School of Medicine and the Detroit Medical Center

Course Director:
Rouba Ali-Fehmi, M.D.


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For more information, please call (313) 745-8555 or
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Case of the Week #232

Clinical History:

A 51 year old woman with uterine leiomyomas underwent a TAH BSO for a 3 cm adnexal mass, which turned out to be a serous cystadenofibroma. The uterus also contained a 3.0 cm white-tan subserosal nodule.

Micro images:

               

What is your diagnosis?































Diagnosis:

Adenomatoid tumor of uterus

Discussion:

Adenomatoid tumors are benign mesothelial tumors present in many different organs, particularly in the male and female genital tracts. The mesothelial cells form slit-like, tubular or gland-like (“adenomatoid”) structures that infiltrate smooth muscle bundles or a fibrous stroma. The tumor cells range from cuboidal to flattened, and thus the gland-like structures can resemble lymphatic channels, signet ring cells or adipocytes; however the tumor cells are positive for mesothelial markers calretinin and HBME-1.

The tumor cell nuclei are cytologically bland and there is little mitotic activity. Ki-67 stains <1% of the tumor cells.1 Despite the invasive-appearing growth pattern, there is no desmoplasia or stromal response. The smooth muscle bundles within the tumor are felt to be hyperplastic rather than neoplastic.1,2 Lymphocytic aggregates or follicles are commonly seen.1

In the uterus, adenomatoid tumors grossly resemble leiomyomas, but adenomatoid tumors are not as well defined and may not bulge out as much from the surrounding myometrium. They may also be softer than a typical leiomyoma.3 Most adenomatoid tumors are subserosal, but may be intramural or even submucosal.

They are usually incidental findings, but can have large cystic spaces and may present as a pelvic mass.1 They are invariably benign.

References:
1. Nogales FF, Isaac MA, Hardisson D, Bosincu L, Palacios J, Ordi J, Mendoza E, Manzarbeitia F, Olivera H, O'Valle F, Krasevic M, Marquez M: Adenomatoid tumors of the uterus: an analysis of 60 cases, Int J Gynecol Pathol 2002, 21:34
2. Crum and Lee: Diagnostic Gynecologic and Obstetric Pathology (2nd edition). Saunders 2011.
3. Tavassoli and Devilee (Eds.): World Health Organization Classification of Tumours. Pathology and Genetics of the Breast and Female Genital Organs. IARC Press: Lyon 2003.


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