Diagnostic challenges in a rare case of müllerian adenofibroma of the uterus: instructive case and literature review

Abstract

We report the clinical, radiological and pathological features of a case of extremely rare müllerian adenofibroma of endometrium in a postmenopausal woman. Although tumour is benign, histopathological features of adenofibroma overlap with its malignant müllerian counterpart, adenosarcoma. A case is presented in which a 60-year-old woman with adenofibroma of endometrium was initially treated with curettage rather than hysterectomy. The radiological imaging was of limited value in specifically diagnosing müllerian adenofibroma and it will virtually never indicate this as a specific diagnosis. Furthermore, the diagnosis of adenofibroma in our patient could not be reliably made from curettage samples only, necessitating further follow-up. Another curettage 2 months later showed the recurrence of adenofibroma, and patient proceeded to have hysterectomy to ensure clearance. This emphasizes that müllerian adenofibroma is associated with recurrence, and that conservative treatments with either curettage or polypectomy are suboptimal. It becomes clear that hysterectomy is the treatment of choice in women with adenofibroma of both, ovulatory and postmenopausal age in order to assure a complete excision and to obtain a thorough sample to exclude adenosarcoma.