INTRODUCTION

Adenomyoma of the uterine cervix sho-wing simultaneous proliferation of the glandand stroma is uncommon (1). It appears as anendometrial polyp projecting into the endomet-rial cavity. Adenomyoma is characterized by amixture of benign gland and stroma consistingpredominantly of benign appearing smoothmuscle (2). Uterine adenomyomas are unusualbenign tumors that can be misdiagnosed becau-se the lesion has received scant attention in theliterature. Uterine adenomyoma usually occursin the uterine corpus and rarely in the endocer-

vix (2-4). Herein we present a case of adenom-yoma of endocervical type due to its rarity. Tothe best of our knowledge, less than 20 cases ofthis entity have been reported so far.

CASE REPORT

A 28-year-old nulliparous woman was ad-mitted to the gynecology clinic with the comp-laint of a mass protruding from the vagina thro-ugh the introitus. Speculum examination revea-led a polypoid mass originating from the cervix.She was treated by polypectomy. The largest di-ameter of the polyp was 5 cm and it was gray-white and well circumscribed. Tissue sampleswere fixed in 10% buffered neutral formalin andembedded in paraffin. Five micron thick secti-ons were stained with hematoxylin and eosin(HE). Immunohistochemical studies were per-

ABSTRACT

We report a case of adenomyoma of endocervical typethat occurred in a 28-year-old-woman. The patient pre-sented with a mass protruding into vagina which wastreated by polypectomy. Histologically, tumor was com-posed of a mixture of proliferating glands of endocervi-cal type and fascicles of smooth muscle cells. There we-re no architectural abnormalities. Both the epitheliumand smooth muscle were uniformly bland. No mitoticactivity was observed in the epithelial and stromal com-ponent. Polypectomized specimen was diagnosed asadenomyoma of endocervical type. This tumor typeshould be added to the list of a differential diagnosis ofuterine endocervical tumor.

Key words: Adenomyoma, endocervical tumors

ÖZET

Yirmi sekiz yafl›nda kad›n hastada endoservikal tipadenomiyom olgusu sunulmaktad›r. Hasta vajen içineuzan›m gösteren kitle yak›nmas› ile baflvurmufl ve poli-pektomi uygulanm›flt›r. Histolojik olarak tümör, yap›-sal anormallik göstermeyen, mitoz içermeyen düz kasdemetleri ile endoservikal bezlerden oluflmaktad›r. Po-lipektomi sonras› tümör, endoservikal tip adenomiyomtan›s› alm›flt›r. Bu tümör uterin endoservikal tümörle-rin ay›r›c› tan›s›na eklenmelidir.

Anahtar sözcükler: Adenomiyom, endoservikal tümörler

Uterine adenomyoma of endocervical type: A case report

Endoservikal tip uterus adenomiyomu: Olgu sunumu

Burçin TUNA1, Erbil DO⁄AN2

Dokuz Eylül University School of Medicine, Departments of Pathology1 and Obstetrics and Gynecology2, ‹ZM‹R

Gelifl tarihi: 13.02.2008Kabul tarihi: 04.03.2008Corresponding Author: Burçin Tuna, Dokuz Eylul UniversitySchool of Medicine, Department of Pathology, 35340, Inciralt›-Izmir

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formed using the avidin-biotin complex (ABC)method. Histologically, the tumor was compo-sed of glands lined by a single layer of endocer-vical-type mucinous epithelium with smoothmuscle fibers (Figure 1). There was no endo-metrial gland in the polyp. Stromal componentconsisted of spindle cells with myxomatouschange. No nuclear atypia was observed in theepithelial and stromal components and, therewas no evidence of destructive stromal invasionsuch as desmoplasia. Immunohistochemically,the spindle cells were strongly positive for actin(Figures 2). In tissue sections the lesion was di-agnosis as adenomyoma of the endocervix. Fiveyears following polypectomy, the patient is wellwithout evidence of recurrence.

DISCUSSION

Adenomyomas of uterus are clinically be-nign. They have both typical and atypical vari-ants, and usually occur in the endometrium, inthe lower uterine segment and rarely in the en-docervix. They grossly resemble endometrialpolyps (3,5). Histopathologically, tumor is com-posed of benign endometrial glands without arc-hitectural abnormality that are arranged hapha-zardly within the smooth muscle whereas; theatypical adenomyoma is composed of irregu-larly shaped hyperplastic glands (3). Gilks et al(6) reported 10 benign cervical tumors descri-bed as “adenomyoma of endocervical type”.Histologically this tumor was composed of amixture of proliferating glands of endocervical(not-endometrial) type and stroma consistingpredominantly of benign appearing smoothmuscle (6). Our findings were consistent withthis definition. They observed three growth pat-tern on macroscopic examination, as follows; i)mural tumor, ii) growth into the endocervicalcanal and iii) prolapse through the external os,as seen in our case. Histopathologic confirmati-on of smooth muscle fibers realized by immuno-histochemical staining with actin and desminand in our case muscle fibers showed strongcytoplasmic positivity for actin and focal positi-vity for desmin.

The differential diagnosis of adenomyomaof endocervical type includes adenoma malig-num and adenosarcoma. The well circumscribedmargin, absence of invasive glands with a des-moplastic stromal reaction and the lack of cyto-logic atypia in adenomyoma helps in differen-tiating it from adenoma malignum. Adenosarco-ma is distinguished from a cervical adenomyo-ma by the distinctive characteristics of the stro-ma such as uniformly bland without significantmitotic activity and lack of leaf-like pattern(3,6-8).

In conclusion, we reported the clinicopat-hologic and immunohistochemical features ofan unusual endocervical tumor diagnosed as

Figure 1. Proliferation of endocervical glands and smoothmuscle (Original magnification, HE x100).

Figure 2. Actin immunoreactivity in smooth muscle cells (Ori-ginal magnification x100).

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Uterine adenomyoma of endocervical type: A case report

adenomyoma of endocervical type. The possibi-lity of adenomyoma of the endocervix should bekept in mind in the differential diagnosis of theuterine endocervical tumors, because of signifi-cant therapeutic implications per se, especiallyin young patients.

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7. Ota S, Ushijima K, Nishio S, Fujiyoshi N, Takemoto S,Terada A, et al. Polypoid endocervical adenomyoma:A case report with clinicopathologic analyses. J ObstetGynaecol Res 2007;33:363-367.

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