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Infectious Diseases in Obstetrics and Gynecology
Volume 11, Issue 1, Pages 59-64
http://dx.doi.org/10.1155/S1064744903000085

Abscess in Adenomyosis Mimicking a Malignancy in a 54-Year-Old Woman

1Department of Pathology, School of Medicine, Inonu University, Turkey
2Department of Obstetrics and Gynecology, School of Medicine, Inonu University, Turkey
3Department of Radiology, School of Medicine, Inonu University, Malatya, Turkey
4Cosnuk Mah, Mehmet Buyruk Cad, Resat Turgut Sitesi B-Blok, No:75 D:26, Malatya TR-44330, Turkey

Received 8 July 2002; Accepted 1 February 2003

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems.

Case: A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 × 85 mm leiomyoma-like lesion including a 53 × 43 mmcystic space and 9 × 6 mmpapillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful.

Conclusion : The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.