A Rare Case of Giant Cystic Adenomatoid Tumor of the Uterus With Literature Review

Our plain-English summary of A Rare Case of Giant Cystic Adenomatoid Tumor of the Uterus With Literature Review, by P.S. Renavikar, L. Adwer, D.G. Wagner, et al (Case Reports in Obstetrics and Gynecology, 2024).

The study

• Authors: P.S. Renavikar, L. Adwer, D.G. Wagner, S.M. Lele
• Journal: Case Reports in Obstetrics and Gynecology
• Published: 2024;2024:7791245
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Adenomatoid tumors are rare benign neoplasms arising from mesothelial cells, commonly found in the female genital system, particularly the uterus and fallopian tubes. The giant cystic variant of adenomatoid tumor is exceptionally rare and can cause massive growth mimicking malignant gynecological conditions. Histology and immunohistochemistry play a crucial role in confirming the diagnosis, with markers such as calretinin, D2-40, CK7, BAP1, ER, and WT1 proving useful. A 51-year-old female with a history of breast cancer presented with pelvic pressure and vague pain. Imaging revealed an enlarged uterus with multiple heterogeneously enhancing masses and a predominantly cystic mass arising from the fundus, all believed to be leiomyomas. Surgical exploration and subsequent pathologic examination identified the cystic tumor as cystic adenomatoid tumor coexisting with leiomyomas, adenomyosis, and abdominal endometriosis. Diagnosing cystic adenomatoid tumor presents challenges, especially in patients with complex gynecologic histories. Cystic adenomatoid tumors typically have a favorable prognosis following surgical intervention. This case demonstrates one of the few reports of a giant cystic adenomatoid tumor (11.5 cm) and highlights diagnostic mimics. As these tumors are typically small and often seen only microscopically, the large size can confuse the pathologist who may be unaware of this feature leading to a misdiagnosis.

Copyright © 2024 Pranav S. Renavikar et al.

In plain English

This article was a case report about one patient, described as a 51-year-old premenopausal female with a history of breast cancer, who had pelvic pressure and vague pelvic pain. The article does not mention asbestos; it notes that the patient's breast cancer had been treated with surgery followed by radiation, but it does not link that treatment to the uterine tumor. Adenomatoid tumors are benign tumors arising from mesothelial cells. Before surgery, imaging suggested the uterine masses were leiomyomas (fibroids). The patient had her uterus, both ovaries and tubes, and a cystic mass attached to the top of the uterus removed. A frozen section examined during surgery favored a benign multicystic lesion. Final pathology found a benign cystic adenomatoid tumor measuring 11.5 cm, with no atypia, necrosis or mitoses seen. Leiomyomas, adenomyosis and abdominal wall endometriosis were also found. The authors wrote that staining confirmed a benign mesothelial cell type. They also wrote that the findings ruled out well-differentiated papillary mesothelioma and potentially ruled out malignant mesothelioma. After 48 months of follow-up there was no evidence of the tumor returning. The authors concluded that this was one of the largest reported cystic adenomatoid tumors.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single patient) with a brief discussion of prior published cases
• Who was studied: One 51-year-old premenopausal female with a history of breast cancer diagnosed one year earlier, treated with lumpectomy and sentinel lymph node biopsy followed by adjuvant radiation. No place or dates of treatment are stated, apart from the University of Nebraska Medical Center review board waiver.
• Main results:
  • A frozen section taken during surgery favored a benign multicystic lesion.
  • Pathological examination of the removed uterine mass showed a benign cystic adenomatoid tumor.
  • The mass measured 11.5 cm in greatest dimension.
  • Under the microscope, no atypia, necrosis or mitoses were seen in the tumor.
  • Additional findings in this patient included leiomyomas, adenomyosis, ovarian cysts and abdominal wall endometriosis.
  • The authors stated that immunostains confirmed a benign mesothelial cell type.
  • The authors stated that the gross and microscopic findings ruled out well-differentiated papillary mesothelioma, and that the frozen section findings potentially ruled out malignant mesothelioma.
  • Over 48 months of follow-up with mammograms and CT scans, there was no evidence of recurrent breast cancer or cystic adenomatoid tumor.
• The authors' conclusion: The authors concluded that this case describes one of the largest reported cystic adenomatoid tumors (11.5 cm). They also wrote that it underscores the importance of comprehensive pathological examination, and that these tumors generally follow a benign course after surgery.

Topics

Medical terms in this study, explained in our Lexicon: Adenomatoid Tumor, Neoplasm, Mesothelial Cells, Histology, Immunohistochemistry, Calretinin, Podoplanin (D2-40), BAP1.

Related studies

• Synchronous occurrence of benign mesothelioma and adenomatoid tumor of uterus: A case report and review of literature — P.R. Shen, J. Cen, et al. (2019)
• Pelvic mass-like florid cystic endosalpingiosis of the uterus: a case report and a review of literature — P. Rosenberg, L. Nappi, et al. (2011)
• Adenomatoid tumors of the uterus — J.C. Quigley, W.R. Hart (1981)
• Localized biphasic malignant mesothelioma presenting as a giant pelvic wall mass: a rare case report and literature review — Y. Liu, J. Wu, et al. (2020)
• Benign cystic mesothelioma of the peritoneum: a rare case and review of the literature — S. Khuri, H. Gilshtein, et al. (2012)
• Composite multicystic mesothelioma and adenomatoid tumour of the uterus: different morphological manifestations of the same process? — J.K. Chan, M.H. Fong (1996)

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