Erguvan Rezzan, Meydanli Mehmet M, Alkan Alpay, Edali Mehmet N, Gokce Hasan, Kafkasli Ayşe
Department of Pathology, School of Medicine, Inonu University, Malatya, Turkey.
Infect Dis Obstet Gynecol. 2003;11(1):59-64. doi: 10.1155/S1064744903000085.
Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems.
A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 x 85 mm leiomyoma-like lesion including a 53 x 43 mm cystic space and 9 x 6 mm papillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful.
The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.
尽管有一些报告描述了子宫内膜异位症病灶中脓肿的形成，但文献中未出现关于子宫腺肌病内新生脓肿形成的报告。由于体征和症状不具特异性，子宫腺肌病的术前诊断常常困难。同步存在的盆腔病变，如平滑肌瘤、子宫内膜息肉、子宫内膜增生以及子宫内膜癌，可能会导致鉴别诊断问题。
介绍一名54岁绝经后女性，主诉腹股沟疼痛、盗汗和潮热。骨盆的放射学检查显示子宫内有一个95×85毫米的平滑肌瘤样病变，包括一个53×43毫米的囊性区域和9×6毫米的乳头状结构，这引起了对恶性肿瘤的临床怀疑。进行了全腹子宫切除术和双侧输卵管卵巢切除术，并进行了冰冻切片诊断。冰冻切片显示在子宫腺肌病病灶中形成了脓肿。患者术后恢复顺利。
据我们所知，本病例是子宫腺肌病中脓肿形成的首例报告。子宫腺肌病内出现的脓肿会强烈引起对子宫内膜癌的怀疑，尤其是在患者绝经后的情况下。如果术前不能通过明确的组织病理学诊断排除子宫内膜癌，那么在手术干预期间进行冰冻切片检查就成为必需。
