Ewha Med J.  2019 Jan;42(1):10-13. 10.12771/emj.2019.42.1.10.

Clear Cell Adenocarcinoma Originated from Adenomyosis

• Park S
• Cho A
• Park CM

• KMID: 2433551
• DOI: http://doi.org/10.12771/emj.2019.42.1.10

Abstract

A 66-year-old postmenopausal woman received routine gynecologic check-up. Transvaginal ultrasonography and abdominal and pelvic computed tomography showed about 5-cm cystic mass in uterus with solid component and the patient had thin endometrium and the serum level of CA 125 was normal. We performed a total hysterectomy and bilateral salpingo-oophorectomy and found tumor which had brownish cystic fluid and about 2 cm sized and colored in light yellowish, polypoid protruding solid mass, located within the myometrial wall. Histopathological examination of frozen section revealed malignancy. The tumor was confined within the myometrium and its histologic type was clear cell adenocarcinoma. Finally we identified that the myometrial mass was clear cell adenocarcinoma originated from adenomyosis pathologically. The malignant transformation of adenomyosis is very rare. When we find a cystic change with solid component in adenomyosis patients, clear cell adenocarcinoma should be suspected as a differential diagnosis and magnetic resonance imaging should be considered for further evaluation.

Keyword

Adenocarcinoma, clear cell; Adenomyosis; Myometrium

MeSH Terms

Adenocarcinoma, Clear Cell*
Adenomyosis*
Aged
Animals
Diagnosis, Differential
Endometrium
Female
Frozen Sections
Humans
Hysterectomy
Magnetic Resonance Imaging
Mice
Myometrium
Ultrasonography
Uterus

Figure

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  Fig. 1 Trans-vaginal ultrasonography showed 5-cm cystic mass in uterus with solid component.

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  Fig. 2 Abdomen pelvic CT revealed a 4.4-cm cystic degenerative mass with enhancing solid portion consistent with myoma in the anterior portion of uterine body. The cystic degenerative mass was located in myometrium, maybe not involved endometrium.

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  Fig. 3 Grossly, the uterus shows a papillary-surfaced solid tumor tissue surrounded by smooth membranous wall and several hemorrhagic foci in the myometrium.

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  Fig. 4 Microscopically, Photomicrographs reveal (A) clear cell carcinoma (arrows) and adenymyosis (block arrows) in the surrounding myometrium and (B) abundant clear cytoplasm of the tumor cells.

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