August 2020 — Gynecological

One consulting slide from a 46 year old female with hysterectomy. The outside pathology diagnosis is inactive endometrium, adenomyosis and leiomyomata. But they send in one slide only to ask question about the adenomyosis.

What is your diagnosis?

  • Direct endometroid adenocarcinoma invasion
  • Endometroid adenocarcinoma arising from adenomyosis
  • Complex adenomyosis
  • Classical adenomyosis

The correct answer is...

The correct answer is Endometroid adenocarcinoma arising from adenomyosis

This fits the invasion by "Microcystic, elongated, and fragmented (MELF) glands​" pattern. Because there is no endometroid adenocarcinoma in the endometrium, this case belongs to the endometroid adenocarcinoma arising from adenomyosis.

1. Mayo Clin Proc 1995 Dec;70(12):1137-41. Accuracy of frozen section diagnosis in surgical pathology: review of a 1-year experience with 24,880 cases at Mayo Clinic Rochester. Ferreiro JA, Myers JL, Bostwick DG
2. Virchows Arch. 2019 Nov;475(5):537-549. Recent advances in invasive adenocarcinoma of the cervix. Stolnicu S, Hoang L, Soslow RA.
3. Curr Gastroenterol Rep. 2019 Feb 28;21(4):10. Inflammation and Neoplasia of the Pouch in Inflammatory Bowel Disease. Khan F, Shen B.
4. Rom J Morphol Embryol. 2018;59(1):13-22. Clinicopathological significance and prognostic value of myoinvasive patterns in endometrial endometrioid carcinoma. Amălinei C, Aignătoaei AM, Balan RA, Giuşcă SE, Lozneanu L, Avădănei ER, Căruntu ID.
5. Mod pathol. 2016 Jan;29 Suppl 1:S59-77. Practical issues related to uterine pathology: staging, frozen section, artifacts, and Lynch syndrome. Soslow RA​

Photo of Yilan Li, M.D. Ph.D., M.D. Yilan Li, M.D., Ph.D.
Resident, Anatomic Pathology (2019-2020)
Mayo Clinic
Photo of Amy Clayton. M.D. Amy Clayton, M.D.
Division Chair, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

MCL Education

This post was developed by our Education and Technical Publications Team.