Images in Clinical Medicine
Mullerian Adenosarcoma and Early Pregnancy
N Engl J Med 2000; 343:1167October 19, 2000
- Article
Figure 1 A 34-year-old mother of two children had had menometrorrhagia, lethargy, and episodic abdominal pain for several months. A trial of oral contraceptives provided no relief. Dilation and curettage was performed; staining of the tissue with hematoxylin and eosin demonstrated mullerian adenosarcoma (Panel A, ×20). One month later, the patient was admitted for a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and a staging procedure. Preoperative testing revealed an elevated serum level of the β subunit of chorionic gonadotropin, which is indicative of early pregnancy. After a consultation during which possible options were explained, the patient decided to proceed with the surgery. Exploration of the pelvis showed no evidence that the tumor had spread beyond the uterus. Sagittal bisection of the uterus showed extensively decidualized endometrium with a gestational sac of 3 to 4 mm protruding from the posterior surface (arrow in Panel B). Staining of the tissue with hematoxylin and eosin (Panel C, ×4) revealed an empty gestational sac composed of immature chorionic villi (V), syncytiotrophoblasts (S), and cytotrophoblasts (C), findings consistent with the presence of a two-to-three-week-old embryo. The patient was discharged without complications three days after surgery and has remained asymptomatic for three years after the diagnosis.
Keith F. Izban, M.D.
Saro Gooneratne, M.D.
Loyola University Medical Center, Maywood, IL 60153
