Uterus-like mass

The uterus-like mass (ULM) is a tumorlike anatomical entity originally described in the ovary in 1981 and thereafter reported in several locations of the pelvis and abdominal cavity including broad ligament, greater omentum, cervix, small intestine, mesentery and conus medullaris. Basically, it is represented by a miniature uterus comprising a smooth muscle wall lined by endometrium thus outlining a uterus anatomical structure. Some of the reported cases have been associated to urinary tract and internal genitalia malformations whereas others appeared as a solitary finding. The term endomyometriosis has also been applied to this lesion.^[1]

Different pathogenetic views have been suggested for this anomaly: a) a metaplastic change in endometriosis foci bringing about smooth muscle hyperplasia; b) a congenital anomaly due to fusion defects of the Müllerian ducts; and c) a sub-coelomic transformation of the mesenchyme.

ULM has also been reported associated to endometrial carcinoma and breast cancer. A clonal chromosome deletion 2p21 was found in endomyometriosis by Verhest et al.^[2] while Pai^[3] evidenced a strict relationship among ULM, breast cancer and elevated serum CA125 supporting the view of ULM being either hormone-dependent or a form of endometriosis.^[4] There have been reports of the finding of occurrence of endometriosis in leiomyomatosis peritonealis disseminata.^[5][6]

More than 15 cases of ULM have been reported so far. A case of ULM was reported 22 years after total hysterectomy, another 17 years after. Abdominal pain and a palpable mass are among the main clinical findings.

Anyway, the phenomenon of smooth muscle cell metaplasia occurring in association with endometriosis (endomyometriosis), as well as of smooth muscle differentiation at endometrio-myometrial junction independently from actually engendering uterus-like configurations in several locations of the pelvis, have been pointed out by several authors.^[7][8]

A magnetic resonance account of this lesion type has been provided by Menn et al.^[9]

Sources

1. Cozzutto C(1981). Uterus-like mass replacing ovary: Report of a new entity. Arch Pathol Lab Med 105: 508-514.
2. Verhest A, Simonart T, Noel JC (1996). A unique clonal chromosome 2 deletion in endomyometriosis. Cancer Genet Cytogenet 1996; 86:174-176.
3. Pai SA, Sangeeta BD, Borges AM (1998). Uterus-like masses of the ovary associated with breast cancer and raised serum CA125. Am J Surg Pathol 22(3):333-337.
4. Tijani E, Meryem T, Lamia GA, Abdelouahed J (2010). Giant uterus-like mass of the uterus. Indian J Pathol Microbiol 53:793-795.
5. Rohling MB, Kao KJ, Woodard BH (1981). Endomyometriosis: Possible association with leiomyomatosis disseminata and endometriosis. Arch Pathol Lab Med 105:556-557.
6. Kuo T, London SN, Dish TV (1980). Endometriosis occurring in leiomyomatosis peritonealis disseminata. Am J Surg Pathol 4:197-204.
7. Fukunaga M(2000). Smooth muscle metaplasia in ovarian endometriosis. Histopathology 36(4):348-352.
8. Fujii S, Konishi I, Mori T (1989). Smooth muscle differentiation at endometrio-myometrial junction. An ultrastructural study. Virchows Arch A Pathol Anat 414:105-112.
9. Menn KA, Qin L, Fedoriw G, Gillette ME, McCarthy S (2007). Uterus-like mass: MRI appearance of a very rare entity. JMRI 26(1):162-164.

Further reading

• Kaeser SA, Ruchti C, Frankhauser G (2008). Uterus-like mass in the great omentum. Geb Frauenh 68(1):88-90.

• Kaufman Y; Lam A (2008). "The pelvic uterus-like mass - A primary or secondary Muellerian system anomaly?". Journal of Minimally Invasive Gynecology. 15 (4): 494–497. doi:10.1016/j.jmig.2008.03.002. PMID 18602050.

• Khurana A, Mehta A, Sardana M (2011). Extrauterine adenomyoma with uterus-like features. A rare entity presenting 17 years post hysterectomy. Indian J Pathol Microbiol 54:572-573.

• Peterson CJ, Strickler JG, Gonzalez R, Dehner LP (1990). Uterus-like mass of the small intestine. Heterotopia or monodermal teratoma? Am J Surg Pathol 14(4):390-394.

• Pueblitz-Peredo S, Luévano-Flores E, Rincòn-Taracena R, Ochoa-Carrillo FJ (1985). Uterus-like mass of the ovary: endometriosis or congenital malformation? A case with discussion of histogenesis. Arch Pathol Lab Med 109:361-364.

• Rahilly MA, Al-Nafussi A (1991). Uterus-like mass of the ovary associated with endometrioid carcinoma. Histopathology 18:549-551.

• Redman R, Wilkinson EJ, Massoll NA (2005). Uterine-like mass with features of an extrauterine adenomyoma presenting 22 years after total abdominal hysterectomy - bilateral salpingo-oophorectomy: A case report and review of the literature. Arch Pathol Lab Med 129(8):1041-1043.