Multicentric infarcted leiomyoadenomatoid tumor: a case report

Adenomatoid tumor is a benign, usually small lesion that may be found within the wall of fallopian tubes or beneath the uterine serosa near the uterine cornu. It is often accompanied by smooth muscle hypertrophy that may obscure the adenomatoid tumor. We herein report a very unusual case of infarcted leiomyoadenomatoid tumor of the uterus and ovary in a 24-year-old woman who presented with severe lower abdominal pain and masses in the uterus and right ovary. Pelvic ultrasonography and computed tomography revealed a 5 cm mass in the myometrium and a 4 cm mass in the right ovary. Laparoscopy-assisted transvaginal mass removal was performed under the clinical impression of a uterine leiomyoma and benign ovarian teratoma. On a microscopic examination, prominent fascicles of smooth muscle separated or infiltrated by cuboidal or signet ring-like vacuolated cells, as well as tubular formations lined by flattened mesothelial cells and extensive necrosis were observed in both masses. The microscopic appearance often suggested the possibility of a malignant neoplasm due to irregular pseudoinfiltration with atypical cuboidal cells and the paucity of a typical adenomatoid tumor due to infarction, and the presence of epithelial-appearing cells in the hypertrophic smooth muscle bundles that mimicked an infiltrating carcinoma for a leiomyoma or myometrium. These unemphasized features of leiomyoadenomatoid tumors may potentially lead to more aggressive therapy than warranted if not correctly interpreted, especially for infarcted cases.