A novel approach in the management of a recurrent adenomatoid tumor of the uterus utilizing a Strassman technique.
Adenomatoid tumors of the uterus are uncommon benign lesions derived from mesothelium, with a prevalence of 1.2% in one study of 1 000 unselected hysterectomy specimens. They are usually small and near the serosal surface; however, they may be large and diffuse (giant adenomatoid tumors). They coexist with leiomyomas in 60% of cases. A 33-year-old nulliparous woman was referred for severe menorrhagia and dysmenorrhea, thought to be due to a submucosal fibroid on ultrasound. This transpired to be an adenomatoid tumor, and she underwent three transcervical resections of the tumor (TCRT) over a period of 12 months for tumor recurrence and failure of symptom resolution. The last TCRT was performed with ultrasound guidance and laparoscopic visualization of the uterus to the resection point of blanching of the serosal surface. She failed to respond to a GnRH analogue throughout. A specialist opinion on the suitability of vascular embolization of the tumor judged that it would be ineffective for this lesion. She then underwent a Strassman procedure and removal of the adenomatoid tumor. This involved dissection of ureters and pelvic vasculature, selective temporary ligation of uterine arteries, hemisection of the uterus, and excision of the tumor with frozen sections to ensure clear tumor margins and resuturing of the uterine halves. Temporary vascular occlusion of the uterine arteries and ovarian vessels allowed a Strassman procedure, which resulted in successful resection of a recurrent giant adenomatoid tumor of the uterus, with fertility preservation in a young nulliparous woman. Two and a half years on there is no evidence of tumor recurrence.
Sieunarine
K
K
Department of Gynaecology, Chelsea and Westminster Hospital at Imperial College School of Medicine (ICSM), London, United Kingdom. krishen23@hotmail.com
Cowie
A S
AS
Bartlett
J D
JD
Lindsay
I
I
Smith
J R
JR
D018254:Adenomatoid Tumor / Q000473:pathology / Q000601:surgery*; D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008026:Ligation; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000098:blood supply*