Extrauterine adenomyomas are rare tumors that present as uterus-like masses. Uterine adenomyomas can show interval changes according to hormone status. However, interval changes in imaging studies have not been reported in adenomyomas. We report a rare case of an extrauterine adenomyoma showing unique interval changes in magnetic resonance imaging.
Adenomyomas are benign uterine tumors consisting of endometrial glands and stroma separated by myomatous smooth muscle. Extrauterine adenomyomas are the uncommon presentation of adenomyomas with extrauterine location. They are grossly and radiologically similar to uterine adenomyoma. Although the histopathogenesis of adenomyomas is still questionable, a few reports have presented evidence of hormonal effects on histopathologic changes. However, the interval change in imaging features of extrauterine adenomyomas has not been previously reported. In the current report, we describe the interval change in the magnetic resonance imaging (MRI) features of an extrauterine adenomyoma.
Case Report
A 41-year-old woman presented with a pelvic mass on transvaginal ultrasound examination. She underwent a classic intrafascial supracervical hysterectomy because of uterine myomas 5 years prior and a right salpingectomy because of chronic salpingitis 3 years prior. Transvaginal ultrasound demonstrated that the pelvic mass was a 4.3- × 3.3-cm, well-defined hypoechoic mass with heterogeneous internal echogenicity. Pelvic MRI showed a well-defined and round mass measuring 4.7 × 4.7 × 3.2 cm in the right cul-de-sac in front of the rectosigmoid colon with homogeneous low signal intensity and hyperintense foci on T1-weighted images (T1WI) ( Figure 1 , A) . On T2-weighted images (T2WI), the mass showed heterogeneous low signal intensity with bright high signal intensity foci, which corresponded to the hyperintense foci in T1WI ( Figure 1 , B). The mass was homogeneously enhanced on contrast-enhanced T1WI ( Figure 1 , C).
Five years prior, the patient had undergone an MR examination before classic intrafascial supracervical hysterectomy, showing a homogeneous and hypointense mass measuring 1.8 × 2.3 cm on both T1WI and T2WI ( Figure 2 ) . Its signal intensity on T1WI was similar to that of the myometrium ( Figure 2 , A). However, it showed very homogeneous low signal intensity without hyperintense portions on T2WI ( Figure 2 , B) and poor enhancement on contrast-enhanced T1WI ( Figure 2 , C).
A mass excision and left salpingo-oophorectomy were performed. Grossly, the cul-de-sac mass appeared as a white rubbery mass measuring 7 × 6 × 4 cm and 50 g in weight. Microscopic examination showed 2 components of the mass consisted of interlacing bundles of smooth muscle fibers and embedded endometrial gland tissue and stroma, leading to diagnosis of adenomyoma ( Figure 3 ) . The left salpingo-oophorectomy specimen showed an endometriotic lesion and a hemorrhagic corpus luteum.
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