EP25.07: Rare adenomatoid tumour of the uterus

Abstract

A 33-year-old, white previously healthy woman (gravida 0, para 0) was referred to our hospital with a gross abdominal tumour, which was diagnosed during routine screening ultrasound. Patient had the sensation of fullness of abdomen, leading to decreased appetite. There was no history of abnormal uterine bleedings. There was no family history of malignancies. The patient had no history of the previous medical or surgical illnesses. Physically, the tumour was firm and bump up to a height of two fingers below the navel. A blood test revealed low hemoglobin level (9,9 g/dl), ca-125 level was 98,9U/ml, ca 19,9 6,8U/ml. A transvaginal ultrasonography demonstrated irregular multilocular-solid lesion measuring 12x10x9cm localised in close connection with posterior uterine wall and the left ovary. Solid component was irregular, did not present any acoustic shadowing and measured 6,3x6,2x6,7cm. Figure 1: Colour Doppler mapping showed intense vascular signals IOTA 4 (M4) within the solid component. In total according to IOTA simple rules, the lesion showed 2 malignant features and no benign features and was classified as suspected of malignancy. Using IOTA ADNEX validation the risk of malignancy was 77%. Without Ca-125 level the risk was 75.3%. Figure 2: Ovarian echostructure appeared normal, but it was not clear if the left ovary or the uterus constituted the origin of the lesion. The patient gave only the consent to remove the lesion. Excision of the tumour was performed during suprapubic laparotomy. The tumour was entirely removed according to the rules of oncologic sterility. The histopathology assessment revealed several multilocular cysts and adenomatoid tumour. They were lined with a single layer of cuboidal or flattened cells without atypia. Actually Patient is asymptomatic and stays in follow-up at our Department.