Rare uterine condition mimics cancer in postmenopausal woman

“This case highlights an important variant of Adenomyosis that potentially mimics an invasive uterine neoplasm."

BUFFALO, NY — February 19, 2025— A new case report was published in Oncoscience’s Volume 12 on February 10, 2025, titled “Diffuse cystic adenomyosis simulating invasive uterine neoplasm on imaging: A postmenopausal diagnostic perplexity!"

Researchers Anusha Devalla, Mishu Mangla, Krishna Ramavath, Shailaja Prabhala, Naina Kumar, and Aparna Jarathi from All India Institute of Medical Sciences report a rare case where a benign uterine condition closely resembled invasive endometrial cancer in an 81-year-old woman. The case highlights the challenges of diagnosing adenomyosis, a condition traditionally seen in younger women, and emphasizes the need for improved imaging and diagnostic protocols.

Adenomyosis occurs when endometrial tissue grows into the muscular wall of the uterus, leading to symptoms such as heavy menstrual bleeding and pelvic pain. It is most found in women of reproductive age. In this case, an elderly patient presented with postmenopausal bleeding and an enlarged uterus, raising concerns about a possible malignant tumor.

"Adenomyosis, especially extensive glandular variant, is an extremely rare cause reported in a postmenopausal woman."

Standard diagnostic tools, including transvaginal ultrasound and contrast-enhanced Magnetic Resonance Imaging (MRI), suggested an aggressive uterine cancer. A preoperative biopsy revealed a thickening of the uterine layer (endometrial hyperplasia), but no malignancy was detected. Because the imaging results were concerning, clinicians decided to remove the uterus, ovaries, and fallopian tubes. Post-surgical analysis revealed that the suspected cancer was a rare variant of adenomyosis with extensive glandular proliferation.

This case demonstrates how adenomyosis can present in unexpected ways, particularly in older women. The study highlights the limitations of current imaging techniques, which often struggle to differentiate between aggressive uterine cancer and benign conditions. This reinforces the need for improved diagnostic criteria and more precise imaging technology to reduce unnecessary surgeries and patient anxiety.

"The varied presentation of Adenomyosis has posed a huge diagnostic dilemma for the clinicians and the radiologists especially with atypical appearances on MRI showing myometrial invasion and diffusion restriction highly indicative of uterine malignancy."

While MRI is a reliable tool for detecting adenomyosis, this study suggests that additional diagnostic methods, such as advanced Magnetic Resonance Spectroscopy and newer ultrasound criteria, could help distinguish between benign and malignant conditions more effectively. The researchers also encourage gynecologists and radiologists to consider adenomyosis in postmenopausal patients with unexplained uterine enlargement and abnormal bleeding.

In conclusion, further studies are needed to refine diagnostic protocols and determine whether certain risk factors make postmenopausal patients more susceptible to this condition. By recognizing the full spectrum of adenomyosis presentations, clinicians can make more informed treatment decisions and avoid unnecessary surgical interventions.

Continue reading: DOI: https://doi.org/10.18632/oncoscience.615

Correspondence to: Anusha Devalla - anushadevalla2@gmail.com

Keywords: cancer, postmenopausal, hyperplasia, aged, 80 and over, endometrial neoplasms, adenomyosis

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