Korean J Obstet Gynecol.  2011 Sep;54(9):561-565. 10.5468/KJOG.2011.54.9.561.

Clear cell adenocarcinoma arising from adenomyosis mimicking leiomyoma: A case report

• Shin YJ
• Cho SE
• Sung CO
• Choi CH
• Bae DS

• KMID: 2274085
• DOI: http://doi.org/10.5468/KJOG.2011.54.9.561

Abstract

The incidence of cancer from adenomyosis is rare. Previously, only two cases of clear cell adenocarcinoma (CCA) arising from adenomyosis have been reported in English literature. Here, we report a case of CCA arising from adenomyosis. A 52-year-old postmenopausal Korean woman presented with complaints of vaginal bleeding and back pain. Endometrial biopsy revealed endometrial polyp with atrophic change and transvaginal ultrasonography showed myomas with cystic change. Magnetic resonance imaging revealed a cystic degenerative mass consistent with leiomyoma in the posterior portion of uterus body. And the serum level of CA-125 was 17.7 U/mL. Hysterectomy revealed a yellow-ten solid mass in the myometrium that was diagnosed as CCA arising from adenomyosis. The tumor was mainly located in the myometrium and transition between adenomyosis and CCA along with endometrial stromal cell was identified. Malignant tumor arising from adenomyosis could be considered as a differential diagnosis when the patient with adenomyosis and intact endometrial surface complained of vaginal bleeding.

Keyword

Adenocarcinoma, clear cell; Endometriosis; Eestrogen receptor; Progesterone receptor; p53

MeSH Terms

Adenocarcinoma, Clear Cell
Adenomyosis
Animals
Back Pain
Biopsy
Diagnosis, Differential
Endometriosis
Female
Humans
Hysterectomy
Incidence
Leiomyoma
Magnetic Resonance Imaging
Mice
Middle Aged
Myoma
Myometrium
Polyps
Receptors, Progesterone
Stromal Cells
Uterine Hemorrhage
Uterus
Receptors, Progesterone

Figure

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  Fig. 1 (A) Magnetic resonance imaging shows two uterine masses. (B) One of the uterine masses have a cystic degenerative change.

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  Fig. 2 (A) Yellowish round mass in the myometrium. (B) Microscopic findings of the mass show typical morphologies of clear cell carcinoma (H&E, ×400). (C) There is no connection between the mass and endometrium (H&E, ×100).

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  Fig. 3 (A) Periphery of the myometrial tumor shows numerous adenomyosis (arrows), which are intimacy related with tumor (H&E, ×200). (B) Clear cell carcinoma (arrows) arising from adenomyosis (H&E, ×200). (C)There is a focal isolated clear cell carcinoma in the endometrium (H&E, ×200). (D) The tumor is negative for p53 immunohistochemistry (Immunohistochemistry, ×200).

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