Extrauterine adenomyomas presenting with previous cesarean s
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Adenomyomas are benign tumors that contain benign endometrial glands and endometrial stroma bordered by leiomyomatous smooth muscle. These tumors usually originate within the uterus. They differ from adenomyosis in that they are well circumscribed masses that have discrete borders which separate them from surrounding tissue.

A 47-year-old woman, with regular menstrual cycles, presented to her benign gynecologist with hip pain. Past medical history is only significant for a cesarean section more than 13 years ago. Pelvic exam revealed an 18 week, anteverted uterus with a palpable 5 cm left adnexal mass.MRI of the abdomen and pelvis showed an enlarged uterus with multiple myomas, a 3 cm complex mass of the right ovary, a 7 cm complex solid mass anterior to the rectum, and a left adnexal mass separate from the ovary(Fig. 1a and b). No lymphadenopathy was noted. Upon initial workup, her blood tumor marker CA 125 was 88.8 Units/mL (normal < 38 Units/mL).

The patient was then sent to Gynecologic Oncology due to concern for leiomyomatosis peritonei or carcinomatosis and subsequently underwent exploratory laparotomy during which total abdominal hysterectomy, left salpingectomy (right tube was absent), right ovarian cystectomy, and excision of multiple masses at the bilateral uterosacral areas and sigmoid mesentery were performed.

On gross examination, multiple tan, firm, whorled nodules were identified in the uterine myometrium consistent with myometrial leiomyomas. One uterine mass (7.4 cm in size) and multiple extrauterine masses (ranging from 3.0 cm to 7.0 cm in size) located in the bilateral uterosacral areas and the sigmoid mesentery were sectioned to reveal a white-tan firm whorled cut surface with some soft areas and cystic changes filled with viscous yellow fluid.

Histologic examination of the uterine mass and multiple extrauterine masses all showed benign endometrial glands and endometrial stroma bordered by leiomyomatous smooth muscle without cytologic atypia or necrosis, consistent with adenomyomas. No evidence of adenomyosis within the uterus was identified. The right complex ovarian cystic mass was a serous cystadenoma. The patient's postoperative period was uneventful and she was discharged on the first postoperative day.

Source: https://www.sciencedirect.com/science/article/pii/S2352578919301134
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