Magnetic resonance imaging of adenoma malignum of the uterine cervix with pathologic correlation: a case report

Abstract

Adenoma malignum (AM) is considered a rare subtype of cervical adenocarcinoma. Although previous reports have described magnetic resonance findings, none of these reports evaluated the utility of diffusion-weighted imaging in the differential diagnosis of AM and other multicystic cervical lesions. We present a case report of an AM that did not show restriction on the apparent diffusion coefficient map, which can be explained by the low cellularity of the tumor. This is consistent with the proper correlation between the diffusion imaging and histopathology of the tumor. In this way, AM can present with high apparent diffusion coefficient values, as in benign cervical lesions. Therefore, the combination of a solid multicystic lesion that invades the cervical stroma on T2-weighted magnetic resonance images and the absence of restriction on the apparent diffusion coefficient map are very suggestive of AM.

Multicystic mucinous adenocarcinoma of the uterine cervix compared with benign multicystic lesions: Multiparametric MR features

“…19 In contrast, Cast an Senar et al opined that high tumoral ADC values can be explained by low-grade atypia and low mitotic activity as found by histology. 13 Our results are consistent with the former viewpoint. The ROI should be drawn to completely exclude the cystic parts.…”

“…Nougaret et al reported that the solid component was easily detected as an area of high signal intensity with respect to the high‐b‐value image, with corresponding restrictions on the ADC map . In contrast, Castán Senar et al opined that high tumoral ADC values can be explained by low‐grade atypia and low mitotic activity as found by histology . Our results are consistent with the former viewpoint.…”

“…These include several pathologic types: adenoma malignum (minimal deviation adenocarcinoma), endometrioid variant, clear cell, serous, etc . The characteristic clinical symptoms are a watery vaginal discharge and bleeding . Unlike other solid cervical cancers, the detection rate by cytologic evaluation in multicystic mucinous adenocarcinoma is only about 30% because the tumors are located deep within the endocervix and exhibit an endophytic growth pattern .…”

“…12 The characteristic clinical symptoms are a watery vaginal discharge and bleeding. 13 Unlike other solid cervical cancers, the detection rate by cytologic evaluation in multicystic mucinous adenocarcinoma is only about 30% 5,14 because the tumors are located deep within the endocervix and exhibit an endophytic growth pattern. 15,16 Therefore, imaging techniques-particularly MRI-play an important role in the preoperative diagnosis.…”

Diagnostic dilemma in cervical endocervicosis

“…Endocervicosis usually does not invade deeply into the cervical stroma and does not contain solid-component enhancement on T2W1-MRI images. In contrast, a multicystic lesion that deeply invades the cervical stroma and contains solid-enhancement portions may indicate a malignant lesion, like carcinoma of the cervix, that usually shows high-signal intensity on T2W1 and post-contrast T1W1 images and low-signal intensity at the cervical stroma on T2 images [ 11 12 ]. In addition, morphologically and radiologically, endocervicosis can mimic adenoma malignum.…”