Extrauterine adenomyoma located in the inguinal region: a ca
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A 44-year-old multiparous woman (gravida 2, para 2), with a gynecologic medical history of two cesarean sections at the age of 26 and 31, presented with a painful non-reducible mass in the right inguinal region without fever or other alarming symptoms. Two months prior to presentation a total laparoscopic hysterectomy was performed (without a salpingo-oophorectomy) because of menometrorrhagia. The intact uterus was removed vaginally and there were no complications in the postoperative phase. Histopathological analysis of the uterus was consistent with the preoperative diagnosis of adenomyosis.

Additionally, two leiomyomas were found, one subserosal and one intramural, with a maximum diameter of 0.8 cm. Clinical examination revealed a palpable non-reducible regular mass of 3.0 ×2.0 cm in the right inguinal region near the round ligament of the uterus. Inguinal ultrasonography (US) showed a 2.2×1.4 cm hypoechoic solid mass suspicious for malignancy. Because of the initial suspicion for malignancy, diagnostic workup also included an ultrasound of the abdomen and a chest X-ray, which showed no abnormalities. Laboratory investigations including white blood cell count, kidney and liver function were within normal ranges. Serology for Bartonella henselae antibodies was negative excluding cat-scratch disease. An ultrasound-guided biopsy was performed to obtain histology.

Microscopic examination of the biopsy showed a leiomyomatous lesion, without signs of malignancy. The surgeon performed a resection of the mass. During the procedure, the mass was located proximal of the inguinal ligament and fixated in the inguinal ring. The mass was removed without any complications. Inspection of the specimen revealed a 1.8 × 1.8 × 1.5 cm white–gray regular mass surrounded by yellow–gray tissue. The histologic findings were consistent with extrauterine adenomyoma. The patient was discharged within 24 h after surgery. The patient remained asymptomatic without any signs of recurrent disease after 1.5 years of follow-up.