Adamek, Dariusz

Okoń, Krzysztof

Pająk, Jacek

Ulatowska-Białas, Magdalena

Polish Journal of Pathology

English

Jagiellonian Univeristy Repository

176UTERUS-LIKE MASSMAGDALENA BIAŁAS1, JACEK PAJĄK2, KRZYSZTOF OKOŃ1 , DARIUSZ ADAMEK11Chair and Department of Pathomorphology, Collegium Medicum, Jagiellonian University, Kraków2Chair and Department of Pathomorphology, Silesia University, KatowiceUterus-like mass (ULM) reported also undera name of “endomyometriosis” or “metriosis” is a rarefinding which was first described in 1981 [1]. It issupposed to be a special form of extrauterine adeno-myoma macroscopically and microscopically imitat-ing the uterus. Until now not more than 20 caseshave been reported in the literature [2] – most ofthem were found in the region of the ovaries. Extrao-varian cases have also been described [2, 3]. Uterus-like mass can be found incidentally, how-ever most cases present with lower abdominal orpelvic pain [4, 5], sometimes accompanied by abnor-mal uterine bleeding [4, 6], weakness of the legs [7],vomiting or diarrhoea.Macroscopically, this cystic lesion is often filledwith hemorrhagic, dense, chocolate coloured orserous fluid. Microscopically, the central cavity of the mass islined by endometrium and surrounded by smooth-muscle bundles, resembling the structure of the uter-ine corpus. The endometrium may consist of smallbut well-organized endometrial glands within typicalstroma or only a thin layer of endometrial stromalined by pseudo-stratified columnar epithelium. Inone case, well-developed secretory-phase endometri-um was described [6]. A small amount of residualovarian tissue can be seen within the mass [8]. Raremitotic figures can be present in the endometrial-type stroma, but neither atypia nor necrosis isdescribed either in the epithelial or mesenchymalcomponent.Immunohistochemical analysis demonstratesoestrogen and progesterone receptors immunoreac-tivity in nuclei of epithelial and stromal cells ofendometrium and in some smooth muscle cells.Staining for CD10 is positive in endometrial stromalcells and smooth muscle actin (SMA) in spindle cells.Uterus-like mass can be accompanied by uterineor renal system congenital anomalies [3, 7], howeverin most patients no such anatomic abnormalitieswere found. Some patients had an elevated CA125level [8, 9]. Preoperatively, in the USG or MRI picture, ULMis sometimes considered malignant, suspicious for anendometrial stromal sarcoma or leiomyosarcoma,with central fluid-filled space interpreted as necrosis.Some ULM can also be misdiagnosed as ovarianendometriotic cyst or leiomyoma. Histogenesis of ULM remains uncertain. Threedifferent theories have been proposed. Uterus-likemass could be a congenital malformation caused bya defect in fusion of mullerian ducts [7]; it could bethe effect of metaplastic transformation of subcelom-ic mesenchyme [10] or be due to heterotopia [3].Most authors favour the first theory. Above all themost important information for the clinicians is thatULM is not a neoplasm. In most patients surgicalremoval of the mass was an adequate treatment. Twopatients received GnRH agonist therapy in addition. References1. Cozzutto C. Uterus-like mass replacing ovary. Arch PatholLab Med 1981; 105: 508-511.2. Carinelli S, Motta F, Frontino G, et al. Multiple extrauterineadenomyomas and uterus-like masses: case reports and reviewof the literature. Fertil Steril 2009; 91: 1956e9-1956e11. Fig. 1. The macroscopic picture of the material sent forpathological examinationQUIZCORRECT ANSWER TO THE QUIZ. CHECK YOUR DIAGNOSIS177UTERUS-LIKE MASSFig. 2-3. Histological findings (haematoxylin-eosin)Fig. 4. Immunohistochemistry: CD10 Fig. 5. Immunohistochemistry: SMA3. Menn KA, Qin L, Fedoriw GD, et al. Uterus-Like mass: MRIappearance of a very rare entity. j magnetic resonance imagine2007; 26: 162-1644. Peterson CJ, Strickler JG, Gonzalez R, et al. Uterus-like massof the small intestin. Heterotopia or monodermal teratoma?Am J Surg Pathol 1990; 14: 390-394.5. Matsuzaki S, Murakami T, Sato S, et al. Endomyometriosisarising in the uterosacral ligament: A case report includinga literature review and immunohistochemical analysis. PatholInternat 2000; 50: 493-496.6. Jung WY, Shin BK, Kim IK. Uterine adenomyoma withuterus-like features. a report of two cases. Int J Surg Pathol2002; 10: 163-166.7. Pueblitz-Peredo S, Luevano-Flores E, Rincon-taracena R, et al.Uteruslike Mass of the Ovary: Endomyometriosis or Congeni-tal Malformation? Arch Pathol Lab Med 1985; 109: 361-364.8. Pai SA, Desai S, Borges AM. Uteruslike masses of the ovaryassociated with breast cancer and raised serum CA125. Am J Surg Pathol 1998; 22: 333-337.9. Kim MJ, Seok SH. Uterus-like mass with features of anextrauterine adenomyoma: a case report and literature review.Korean J Pathol 2007; 41: 347-351.10. Redman R, Wilkinson EJ, Massoll NA. Uterine-like masswithe features of an extrauterine adenomyoma presenting 22 years after total abdominal hysterectomy-bilateral salpin-go-oophorectomy. Arch Pathol Lab Med 2005; 129: 1041-1043.Address for correspondenceMagdalena Białas MD, PhDDepartment of Pathomorphology ul. Grzegórzecka 1631-531 Kraków fax +48 12 411 97 25 e-mail: mbialas7@gmail.comTHE AUTHORS OF CORRECT DIAGNOSIS IS:Kamil Winnik MD, Janusz Korczak Memorial Provincial Specialist Hospital in Słupsk, Department of Pathomorphology, ul. Hubalczyków 1, 76-200 Słupsk

Uterus-like mass

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Uterus-like mass

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