Diffuse uterine adenomatoid tumor in a patient with chronic hepatitis C virus infection.

Uterine adenomatoid tumors are usually solitary lesions. Adenomatoid tumors diffusely infiltrating the entire myometrium have rarely been reported in the literature. A feature common to half of the reported cases of diffuse uterine adenomatoid tumor was an immunocompromised status of the patient caused by the medications for renal transplantation. In this article, we describe an unusual case of diffuse uterine adenomatoid tumor in a patient with chronic hepatitis C virus infection. Pelvic examination showed an irregular and enlarged uterus. Supracervical hysterectomy and bilateral salpingo-oophorectomy was performed with a clinical diagnosis of uterine leiomyoma. Pathological examination showed, in addition to multiple leiomyomas, diffuse uterine adenomatoid tumor. We suggested that the diffuse pattern in our patient might be related to immunosuppression secondary to chronic hepatitis C virus infection.

Diffuse uterine adenomatoid tumor in an immunosuppressed renal transplant recipient.

A case of diffuse adenomatoid tumor of the uterus in an immunosuppressed renal transplant recipient is reported and compared with two previously reported, similar cases. The multinodular uterine lesion grossly resembled intramural leiomyomata except for a mucoid cut surface and a cystic serosal component. The predominant patterns of the tumor were adenoid and angiomatoid with less prominent solid and cystic patterns. Immunohistochemical and ultrastructural studies confirmed the mesothelial nature of the tumor cells. Additionally, there was strong diffuse immunoreactivity for proliferating cell nuclear antigen, a low expression of Ki-67, and weak nuclear p53 staining. The relationship between immunosuppression and diffuse adenomatoid tumors is discussed.

Adenomatoid tumor of the uterus in a patient with chronic renal failure.

A case of adenomatoid tumor of the uterus in a 34-year-old patient, who had received a renal transplant and was undergoing immunosuppresive therapy is presented. At surgery, there were a total of eight nodular intramural and subserous masses thought to be leiomyoma nodules, and tumor excision was unusually, hardly performed because the nodules were strictly adherent to the myometrium. All the specimens yielded the same pathological diagnosis - adenomatoid tumor. This case is unusual because of the multiple nodular pattern and its association with the immunocompromised status of the patient. Although adenomatoid tumors have not been shown to recur, we are in doubt in our case, because the uterus is still intact and the immunocompromised status of the patient might have a role in the extensive growth and also in the possibility of recurrence.

Uterine adenomatoid tumors: immunohistochemical characteristics with emphasis on Ber-EP4 immunoreactivity and distinction from adenocarcinoma.

Uterine adenomatoid tumors (UATs) may be difficult to distinguish from metastatic adenocarcinoma, particularly in pelviscopic biopsy specimens, myomectomy specimens, or endometrial samplings. This problem may arise because of the infiltration of vacuolated mesothelial cells between fascicles of prominent smooth muscle, which is a characteristic feature in UAT. This diagnostic difficulty has led to inappropriate surgery as reported in the past. Eleven UATs were studied to clarify the differences between these tumors and metastatic adenocarcinoma. Six of the tumors were grossly indistinguishable from leiomyomas. Histologically, the neoplastic mesothelial cells diffusely infiltrated smooth muscle fascicles in all cases, mimicking the pattern of metastatic adenocarcinoma. Immunohistochemical studies using antikeratin and Ber-EP4 antibodies were positive in the mesothelial component in all 11 and nine tumors, respectively, whereas all 11 UATs were negative using antibodies to carcinoembryonic antigen, CD15, TAG-72, and epithelial membrane antigen. Immunoreactivity using Ber-EP4 was focal, membranous, and usually weak, although a strong signal was present in one case. Immunoreactivity using Ber-EP4 (compared with negativity reported for mesothelial proliferations of other sites) may be related to the unique müllerian characteristic of the female peritoneum. Although nonimmunoreactivity for Ber-EP4 favors a diagnosis of UAT over that of adenocarcinoma, Ber-EP4 immunoreactivity does not exclude UAT.