Renavikar Pranav S, Adwer Lina, Wagner David G, Lele Subodh M
Department of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA.
College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Case Rep Obstet Gynecol. 2024 Oct 23;2024:7791245. doi: 10.1155/2024/7791245. eCollection 2024.
Adenomatoid tumors are rare benign neoplasms arising from mesothelial cells, commonly found in the female genital system, particularly the uterus and fallopian tubes. The giant cystic variant of adenomatoid tumor is exceptionally rare and can cause massive growth mimicking malignant gynecological conditions. Histology and immunohistochemistry play a crucial role in confirming the diagnosis, with markers such as calretinin, D2-40, CK7, BAP1, ER, and WT1 proving useful. A 51-year-old female with a history of breast cancer presented with pelvic pressure and vague pain. Imaging revealed an enlarged uterus with multiple heterogeneously enhancing masses and a predominantly cystic mass arising from the fundus, all believed to be leiomyomas. Surgical exploration and subsequent pathologic examination identified the cystic tumor as cystic adenomatoid tumor coexisting with leiomyomas, adenomyosis, and abdominal endometriosis. Diagnosing cystic adenomatoid tumor presents challenges, especially in patients with complex gynecologic histories. Cystic adenomatoid tumors typically have a favorable prognosis following surgical intervention. This case demonstrates one of the few reports of a giant cystic adenomatoid tumor (11.5 cm) and highlights diagnostic mimics. As these tumors are typically small and often seen only microscopically, the large size can confuse the pathologist who may be unaware of this feature leading to a misdiagnosis.
腺瘤样瘤是一种罕见的起源于间皮细胞的良性肿瘤，常见于女性生殖系统，尤其是子宫和输卵管。腺瘤样瘤的巨大囊性变体极为罕见，可导致肿块巨大，类似恶性妇科疾病。组织学和免疫组织化学在确诊中起着关键作用，钙视网膜蛋白、D2-40、细胞角蛋白7、BAP1、雌激素受体和WT1等标志物被证明是有用的。一名有乳腺癌病史的51岁女性出现盆腔压迫感和隐痛。影像学检查显示子宫增大，有多个不均匀强化的肿块，以及一个主要起源于子宫底部的囊性肿块，所有这些都被认为是平滑肌瘤。手术探查及随后的病理检查确定囊性肿瘤为囊性腺瘤样瘤，与平滑肌瘤、子宫腺肌病和腹腔子宫内膜异位症并存。诊断囊性腺瘤样瘤存在挑战，尤其是在有复杂妇科病史的患者中。囊性腺瘤样瘤在手术干预后通常预后良好。本病例展示了为数不多的关于巨大囊性腺瘤样瘤（11.5厘米）的报告之一，并突出了诊断上的相似情况。由于这些肿瘤通常较小，且往往只能在显微镜下看到，其巨大的尺寸可能会使病理学家感到困惑，他们可能不知道这一特征，从而导致误诊。
