A case of cystic adenomatoid tumor resected after nine years of observation and two full-term deliveries

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  • OGURA Eri
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • ABIKO Kaoru
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • YAMAGUCHI Ken
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • KONDOH Eiji
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • BABA Tsukasa
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • KIDO Aki
    Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine
  • MATSUMURA Noriomi
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • KONISHI Ikuo
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine

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Other Title
  • MRIで長期間経過を追い2度の妊娠・分娩を経験したcystic adenomatoid tumorの1例
  • 症例報告 MRIで長期間経過を追い2度の妊娠・分娩を経験したcystic adenomatoid tumorの1例
  • ショウレイ ホウコク MRI デ チョウキカン ケイカ オ オイ 2ド ノ ニンシン ・ ブンベン オ ケイケン シタ cystic adenomatoid tumor ノ 1レイ

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Abstract

<p>Adenomatoid tumor is a benign neoplasm of mesothelial origin that occasionally arises in the uterus. Among the four reported histologic types of adenomatoid tumor, the cystic type often presents as a large mass. The differential diagnosis is extensive, and includes degenerated leiomyoma and ovarian tumor. We report a patient with cystic adenomatoid tumor who underwent hysterectomy after two full-term pregnancies and nine years of observation with MRI studies. A 31-year-old nulliparous woman was referred to another hospital because of lower abdominal pain. She was diagnosed with a uterine tumor, and was referred to our hospital. Magnetic resonance imaging (MRI) revealed a 5 cm multilocular cystic tumor in the left posterior wall of the uterine body. The mass showed high intensity on T2-weighted MR images, and low intensity on T1-weighted images. Either cystic adenomatoid tumor or degenerated uterine myoma was suspected. We recommended surgical removal, but the patient preferred observation. She became pregnant two times and had normal vaginal deliveries at 40 weeks of gestation when she was 31 and 33 years old, respectively. When she was 39 years old, MRI revealed that the tumor was enlarged to 9.5 cm in diameter. She requested surgery, and hysterectomy was performed. Laparotomy revealed a fist-sized multicystic mass originating in the left posterior wall of the uterine body, with extension into the peritoneal cavity. The capsule of the mass was ruptured, and tenacious fluid was leaking into the abdominal cavity. Histopathologic examination showed multicystic spaces lined by a single layer of cuboidal or flattened cells. Immunohistochemical staining for calretinin and podoplanin was positive and cystic adenomatoid tumor of the uterus was diagnosed. This case suggests that MRI plays an important role in managing cystic adenomatoid tumor when fertility preservation is desired. [Adv Obstet Gynecol, 69 (2) : 107-112 , 2017 (H29.5)]</p>

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