Rationale: Cervical adenomyoma is a rare benign tumor that is easily confused with malignant diseases of the cervix, including malignant and benign cervical diseases. Misdiagnosis results in mistakes in therapy. This study aims to enhance the understanding of cervical adenomyoma through a case report, including clinical symptoms, physical examination, and surgical photos, at the same time a systematic review of cervical adenomyoma will be done, thereby helping to avoid clinical misdiagnosis. Patient concerns: A 39-year-old woman with a cervix mass about 3 × 3 cm. The root of the tumor was located in the cervical canal, and contact bleeding was positive. The pap smear and human papillomavirus test were normal. The menstrual cycle was normal. Ultrasonography revealed that the uterus and bilateral ovaries were normal. There is no relevant family history. Cervical hyperplasia or cervical myoma was considered before surgery. Diagnoses: The patient was diagnosed with cervical adenomyoma. Interventions: Hysteroscopy was taken, and histopathology was taken after surgery. Outcomes: Histopathology revealed that the lesions were mixed cervical glands with smooth muscles. Lessons: Through the case report, we gain a better understanding of the diagnosis of cervical adenomyoma. Histopathology and immunohistochemical staining were conducive to diagnose cervical adenomyoma. A review of existing literature helps distinguish it from other benign and malignant cervical tumors, thereby reducing misdiagnosis.

Objective To investigate the value of transabdominal combined transvaginal color Doppler ultrasonography in the diagnosis of uterine adenomyoma. Methods A total of 80 patients with suspected uterine adenomyoma in our hospital from January 2019 to December 2021 were selected as the study subjects. All of them were examined by transabdominal color Doppler ultrasound (TA-CDUS) and transvaginal color Doppler ultrasound (TV-CDUS), and the postoperative pathological examination results were taken as the gold standard to analyze the diagnostic efficacy of different examination methods for uterine adenomyoma. Results By postoperative pathological biopsy, 46 cases (57.50%) were diagnosed as positive and 34 cases (42.50%) were diagnosed as negative, including 29 cases of uterine adenomyoma and 5 other cases. The sensitivity, accuracy, and negative predictive value of TA-CDUS combined with TV-CDUS in the diagnosis of adenomyoma were higher than those of TA-CDUS (P < 0.05), and the Kappa value between TA-CDUS and pathological diagnosis was 0.923, which was higher than the 0.615 between TV-CDUS and pathological diagnosis. TA-CDUS combined with TV-CDUS showed that there were significant differences in the distribution of Adier blood flow grades between patients with uterine adenomyoma and uterine fibroids (P < 0.05), and the Adier blood flow grades of patients with uterine adenomyoma were mainly grade 0 and grade I; and the resistance index (RI), peak systolic velocity (Vs), and pulsatile index (PI) in patients with uterine adenomyoma were higher than those in patients with uterine fibroids (P < 0.05). Conclusion Compared with TA-CDUS, TA-CDUS combined with TV-CDUS is more sensitive and accurate in the diagnosis of uterine adenomyoma and has a good consistency with pathological diagnosis results. Attention should be paid to the blood flow parameter values in the differential diagnosis of uterine fibroids.

Atypical polypoid adenomyoma (APA) is a polypoid biphasic lesion of low malignant potential that arises in the lower uterine segment and uterine corpus. The diagnosis of APA is often challenging on biopsy and curettage specimens, and both benign and malignant processes need to be considered in the differential. Stromal expression of p16 and SATB2 have recently been shown to distinguish APA from myoinvasive endometrioid carcinoma. The authors hypothesized that p16 and SATB2 immunohistochemistry could also aid in the distinction of APA from benign adenomyomatous polyp and endometrioid adenomyoma. The study comprised 10 APAs, 7 adenomyomatous polyps, 11 endometrioid adenomyomas, and 10 myoinvasive endometrioid carcinomas. The majority of APAs showed moderate to strong, diffuse p16 and stromal expression. However, most adenomyomatous polyps and endometrioid adenomyomas also exhibited moderate to strong, focal to diffuse p16 stromal expression. SATB2 showed weak to moderate, focal to diffuse expression in the majority of APAs, adenomyomatous polyps and endometrioid adenomyomas. In contrast, p16 and SATB2 were negative to weak and focal in 90% of myoinvasive endometrioid carcinomas. Our findings demonstrate that p16 and SATB2 may be helpful in the differential diagnosis of myoinvasive endometrioid carcinoma and APA while not useful in separating APA from adenomyomatous polyp and endometrioid adenomyoma.

Background and AimsCystic adenomyoma is a rare focal cystic variant of adenomyosis, and giant lesions are particularly uncommon. Malignant transformation has been reported in endometriosis‐related disease, but the molecular features of cystic adenomyoma, especially in adults, remain unclear. We are aimed at describing a premenopausal patient with two giant cystic adenomyomas, including the largest lesion reported to date, and to explore a possible pathogenic mechanism using immunohistochemistry.MethodsA 47‐year‐old nulliparous premenopausal woman presented with progressive abdominal distension and urinary symptoms. Imaging showed two large hemorrhagic cystic masses adjacent to a mildly enlarged fibroid uterus, and ovarian endometriotic cysts were suspected preoperatively. The patient underwent hysterectomy with bilateral salpingo–oophorectomy. Gross, histologic, and immunohistochemical examinations were performed on the uterus and cystic lesions. Clinical follow‐up was obtained for 10 months.ResultsSurgery revealed two cystic adenomyomas measuring 30 and 10 cm, contiguous with the uterus but separate from both ovaries. The thick cyst walls were composed of smooth muscle bundles, and the inner surfaces were lined by a single layer of endometrial‐type epithelium; multiple foci of conventional adenomyosis were also present. In the cystic adenomyomas, glands were HNF‐1β+, pAKT+, estrogen receptor+, PTEN−, PIK3CA−, and ARID1A− with a p53 wild‐type pattern. Eutopic endometrial glands were HNF‐1β+, PIK3CA+, pAKT+, ARID1A+, and p53+, with mixed PTEN‐positive and ‐negative glands. The postoperative course was uneventful, and no recurrence was observed at 10 months.ConclusionThis case represents the largest cystic adenomyoma reported to date and the first adult case characterized in detail by immunohistochemistry. Differential PTEN and ARID1A expression between eutopic endometrium and cystic adenomyomas supports a model in which PTEN‐deficient endometrial clones invade the myometrium to form adenomyosis, with additional ARID1A loss and pAKT activation driving cystic enlargement without malignant transformation.