Redman Rachel, Wilkinson Edward J, Massoll Nicole A
Department of Pathology, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
Arch Pathol Lab Med. 2005 Aug;129(8):1041-3. doi: 10.5858/2005-129-1041-UMWFOA.
Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is a rare entity. We report a uterine-like mass consistent with an extrauterine adenomyoma presenting 22 years following a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The mass was pear-shaped with uterine-type smooth muscle and a cavity lined by functional endometrial glands and stroma. To our knowledge, only 4 other cases of an extrauterine uterine-like mass are reported in the literature. Three involved the ovary, while one was located adjacent to the broad ligament with normal pelvic organs. Although none of these other uterus-like masses were described as adenomyomas with uterine-like features, the histologic findings are strikingly similar. An understanding of the müllerian system suggests that either an embryologic malformation or a differential multipotentiality existing in the subcoelomic tissues in response to hormonal stimulation results in a supernumerary müllerian structure like a uterus, as observed in this case. The presence of endometrial glands and stroma in the mass confirms that the tissues in this mass are hormonally responsive. It is most likely that this uterine-like mass arose from the tissues of the secondary müllerian system in response to estrogenic stimulation.
腺肌瘤是一种由平滑肌和良性子宫内膜组成的良性肿瘤。这些肿瘤通常起源于子宫。子宫外腺肌瘤是一种罕见的实体。我们报告了一例子宫样肿块，符合子宫外腺肌瘤，在全腹子宫切除术和双侧输卵管卵巢切除术后22年出现。该肿块呈梨形，有子宫型平滑肌，腔内衬有功能性子宫内膜腺体和间质。据我们所知，文献中仅报道了另外4例子宫外子宫样肿块。其中3例累及卵巢，1例位于阔韧带附近，盆腔器官正常。虽然这些其他子宫样肿块均未被描述为具有子宫样特征的腺肌瘤，但其组织学表现惊人地相似。对苗勒管系统的理解表明，胚胎发育畸形或体腔下组织中存在的差异多能性对激素刺激作出反应，导致出现像子宫这样的多余苗勒管结构，如此病例所见。肿块中存在子宫内膜腺体和间质证实该肿块组织对激素有反应。这个子宫样肿块很可能是继发苗勒管系统的组织在雌激素刺激下形成的。
