Polypoid endometrial adenomyoma in a postmenopausal woman, mimicking cervical cancer, associated with ovarian thecoma

Atypical polypoid adenomyoma (APA) usually occurs in premenopausal women and arises from the endometrium. APAs protruding into the external os may lead to diagnostic problems.

We present a case of APA in a 62-year-old postmenopausal woman, prolapsing through the external os, clinically mimicking cervical cancer FIGO IB2 (4.5 cmx3 cmx3 cm). Histologically the tumor was composed of endometrioid-like with slight cellular atypia and endocervical-type mucinous glands admixed with smooth muscle bundles, exhibiting low Ki-67 antigen immunostaining. The the left adnexa contained an ovarian thecoma.

To the best of our knowledge, this is the first case of APA in a postmenopausal woman, mimicking cervical cancer and associated with ovarian thecoma. Pathogenetically it is proposed, that hyperestrogenism and, in the present case accompanied by progestin production of questionable source, may play an important role in the development of APAs with the admixture of endometrial and endocervical glands.