Orlando Jennie, deRiese Cornelia, Blackwell Eric, Graham Suzanne, Phy Jennifer
Department of Obstetrics and Gynecology and Texas Tech University Health Sciences Center, Lubbock, Texas.
Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas.
Biores Open Access. 2018 Oct 26;7(1):159-164. doi: 10.1089/biores.2018.0023. eCollection 2018.
Adenomatoid uterine tumors are rare, and their appearance on medical imaging modalities is not well established. We present a case of an adenomatoid uterine tumor reviewing a unique sonographic presentation, magnetic resonance imaging (MRI), gross surgical appearance of the tumor, and microscopic pathology images. A 29-year-old gravida 0 Caucasian woman presented with dysmenorrhea, menorrhagia, and desire to conceive. Transvaginal ultrasound revealed a 2.7 cm round, well-circumscribed posterior intramural uterine mass. The mass was hyperechoic centrally with a thin hypoechoic rim. Color Doppler imaging revealed a prominent vascular rim around the periphery of the mass as well as central vascularity not typical for a leiomyoma. MRI, with and without intravenous gadolinium, was obtained showing a 2.7 cm posterior fundal mildly enhancing uterine mass suggestive of leiomyoma. The mass had a heterogeneous signal pattern on T2-weighted images, and no fat component was noted within the mass. Repeat transvaginal ultrasound showed interval growth of the mass to 3.5 cm with a lipomatous appearance. Adenomatoid uterine tumors are rare and may be mistaken for uterine leiomyomata. Unique features include sonographic appearance of central hyperechogenicity with a hypoechoic rim and prominent peripheral and central vascularity in conjunction with MRI revealing a heterogeneous signal pattern on T2-weighted images without fat component. Gross surgical appearance reveals a nondiscrete capsule and secretion of mucoid material when the mass is exposed. We present a case of adenomatoid tumor providing sonographic, MRI, surgical, and pathological correlation. The patient subsequently conceived spontaneously and delivered at term by cesarean section. The patient underwent a preoperative evaluation with complete blood count, comprehensive metabolic panel, blood type with antibody screen, and pregnancy test. She underwent laparoscopic excision with robotic assistance for removal of the tumor. Grossly, the uterine mass had a very soft consistency atypical for a uterine leiomyoma making dissection more challenging. During dissection the mass diffusely secreted a mucoid material although the capsule was not disrupted. The lesion was excised intact and was removed from the peritoneal cavity in an endocatch bag without internal morcellation. Microscopic examination revealed an adenomatoid tumor.
腺肌瘤样子宫肿瘤较为罕见，其在医学影像检查中的表现尚未完全明确。我们报告一例腺肌瘤样子宫肿瘤，回顾其独特的超声表现、磁共振成像（MRI）、肿瘤的大体手术外观及微观病理图像。一名29岁未孕的白人女性，因痛经、月经过多及有生育意愿前来就诊。经阴道超声检查发现一个2.7厘米圆形、边界清晰的子宫肌壁间后壁肿物。肿物中央呈高回声，周边有一薄层低回声边缘。彩色多普勒成像显示肿物周边有明显的血管环，且中央有血管分布，这并非平滑肌瘤的典型表现。行MRI检查，静脉注射钆对比剂前后成像显示一个2.7厘米的子宫底部后壁轻度强化肿物，提示为平滑肌瘤。该肿物在T2加权图像上信号不均匀，且肿物内未发现脂肪成分。再次经阴道超声检查显示肿物增大至3.5厘米，呈脂肪瘤样外观。腺肌瘤样子宫肿瘤较为罕见，可能被误诊为子宫平滑肌瘤。其独特特征包括超声表现为中央高回声、周边低回声边缘及明显的周边和中央血管分布，同时MRI显示T2加权图像上信号不均匀且无脂肪成分。大体手术外观显示肿物无明显包膜，肿物暴露时可见黏液样物质分泌。我们报告一例腺肌瘤样肿瘤，提供超声、MRI、手术及病理的相关性。患者随后自然受孕并足月剖宫产分娩。患者术前进行了全血细胞计数、综合代谢指标检测、血型及抗体筛查和妊娠试验等评估。她在机器人辅助下行腹腔镜肿瘤切除术。大体上，子宫肿物质地非常软，这与子宫平滑肌瘤不同，增加了手术分离的难度。手术分离过程中，肿物弥漫性分泌黏液样物质，尽管包膜未破裂。病变完整切除，装入内套袋从腹腔取出，未进行内部碎解。显微镜检查显示为腺肌瘤样肿瘤。
