Cystadenofibroma, adenofibroma, and malignant adenofibroma of the ovary.
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Adenofibroma↗
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The association of benign and malignant ovarian adenofibromas with breast cancer and thyroid disorders.
An unexpected association with breast cancer and thyroid disorders was found during a review of 91 cases of benign and malignant ovarian adenofibromas. Sixty-three tumors were benign, 11 had areas of borderline neoplasms, and 17 had a component of carcinoma. Such tumors were divided into glandular/cystic (61 cases) and papillary (30 cases) according to their gross and microscopic appearance. Among the 61 patients with glandular/cystic adenofibromas, 13 (21%) had breast cancer and 19 (31%) also had thyroid disorders. Among the 30 patients with papillary adenofibromas there were no cases of breast cancer and only 2 patients had thyroid disorders. The average age of the patients with ovarian adenofibroma and breast cancer or thyroid disorders was higher (66 years) than that of patients without breast cancer or thyroid disorders (55 years). More patients with breast cancer and thyroid disorders had bilateral adenofibromas than patients without breast cancer or thyroid disorders. We also reviewed the medical records of 100 patients with ovarian cancer without adenofibroma component, 100 patients with breast cancer, and 100 patients with ovarian and breast cancer. Six percent of patients with ovarian cancer had breast cancer and 16% of each one of these groups had thyroid disorders. This unexpected association found between glandular/cystic adenofibromas, breast cancer, and thyroid disorders might be explained by defects common to these organs. Disorders of some of these organs have been linked by common genetic changes and it is known that these organs are under the influence of similar hormones. Mutations of PTEN have been found in breast and thyroid cancer. The thyroid and ovaries are controlled by glycoprotein hormones of the pituitary gland, which have common alpha subunits.
Adenofibroma↗
[The malignant potential of adenofibroma and cystadenofibroma of the ovary and mesovarium. 118 cases including 13 proliferative and 5 carcinomatous].
The relationship between adenofibroma and cystadenofibroma and the frequency and features of carcinomas developed on these benign tumours are little known. Eight-hundred and forty-five epithelial tumours of the ovary diagnosed over a 10-year period have been re-examined. One-hundred and eighteen adenofibromas and cystadenofibromas were recorded. One-hundred were benign and formed an architectural spectrum from which emerged: (1) surface papillary adenofibroma accounting for 5% of the cases and appearing at a mean age of 27 years; (2) cystadenofibroma in 77.5% of the cases at a mean age of 53 years; (3) adenofibroma in 17.5% of the cases at a mean age of 64 years. Adenofibroma was bilateral in 18 cases. Among the other cases were an endometrioid cyst and two simple serous cysts. The cells were serous in 110 cases, mucinous in 6 cases and weakly acidophilic to clear in 2 cases. Eighteen of these tumours were malignant: 13 were associated with epithelial hyperplasia and 5 with a carcinoma. The 13 adenofibromas with atypical epithelial hyperplasia (at a mean age of 60 years) were all made of serous cells; 6 of them were low-grade and 7 high-grade tumours with 3 microinvasions. One patient died at the age of 78, of an unknown cause; the others are still alive after a mean follow-up of 11.3 years. The 5 invasive carcinomas appeared on an adenofibroma at the mean age of 70 years; 3 patients died (2 of metastases), one is alive after 9 years and one was loss sight of.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenofibroma↗
Adenofibroma of the uterus: multiple recurrences following wide local excision.
The uterine adenofibroma is a form of mixed mesodermal tumor in which both epithelial and stromal components are benign. A case is presented in which a patient with this lesion was treated with excision of the tumor rather than hysterectomy. Two years later, she developed a recurrence of the lesion, which was again treated with wide local excision. A hysterectomy was done 9 months later, and a polypoid lesion was noted in the fundus of the uterus which on histologic examination was thought to be potentially either an adenofibroma precursor or a maturation of the previous cellular adenofibroma. Since uterine adenofibroma usually occurs in older patients, the standard treatment has been hysterectomy. Because of this patient's age, she was initially treated with a more conservative approach. However, despite the fact that the uterine adenofibroma is a benign lesion, it has an obvious potential to recur when treated conservatively.
Adenofibroma↗
Adenofibroma and adenosarcoma of the uterus: a clinicopathologic study of 35 cases.
The clinical and histopathologic features of ten adenofibromas and 25 adenosarcomas of the uterus were studied. The most useful criterion for distinguishing adenofibroma from adenosarcoma was the frequency of mitotic figures found in the stroma. Adenofibromas had fewer than four mitotic figures per 100 HPF in the most active areas; adenosarcomas had four or more. Myometrial invasion, histologically malignant heterologous mesenchymal elements, and marked atypia of stromal cells were histologic features detected only in adenosarcoma. Of the women with adenosarcoma, ten (40%) had recurrences, with a median interval to recurrence of five years. The only morphologic feature that correlated with aggressive behavior of adenosarcoma was deep myometrial invasion. Adenofibroma and adenosarcoma are in the family of mixed mesodermal tumors, but are distinct clinical and pathologic entities.
Adenofibroma↗
A pregnant woman with clear cell adenocarcinoma of the ovary arising from endometriosis and with benign and borderline adenofibroma of the clear cell and endometrioid types.
We encountered a case of ovarian cancer in a 33-year-old, 8-week pregnant woman. Histological examination revealed both a transitive form of ovarian endometriosis with marked decidual changes due to pregnancy and clear cell carcinoma. Benign and borderline clear cell adenofibroma and benign and borderline endometrioid adenofibroma were also found. Parts of these adenofibromas showed transformation to clear cell carcinoma. This case suggests that clear cell carcinoma can arise from clear cell adenofibromas and/or ovarian endometriosis, even in young patients.
Adenocarcinoma, Clear Cell↗
Nephrogenic adenofibroma in a young child.
Nephrogenic adenofibroma is a benign renal tumor in children and young adults described by Hennigar and Beckwith in 1992. Seven cases have been described, and we report the first case in an 11-month-old child, in good health, revealed by a macroscopic hematuria. Nephrogenic adenofibroma is an unusual tumor, which was difficult to distinguish from nephroblastoma and mesoblastic nephroma. Beckwith makes a distinction between this principal differential diagnosis in child renal tumors based upon morphologic and immunohistochemical patterns. In our observation, the diagnosis remained difficult and needed several reviews of our case. Beckwith proposed the final diagnosis: nephrogenic adenofibroma with stromal predominance. The prognosis is excellent and no treatment is indicated. A FISH analysis of the tumor cells found a trisomy 11. Trisomy 11 has been reported in mesoblastic nephroma as the most frequent chromosomal abnormality. This finding in tumor cells provides an argument for excluding the diagnosis of nephroblastoma but can not clarify the difference between nephrogenic adenofibroma and mesoblastic nephroma.
Adenofibroma↗
[A light and electron microscopic studies of müllerian adenofibroma of the uterus].
Müllerian adenofibroma composed of both histologically benign epithilia and benign mesenchyme is considered to be a rare entity of mixed müllerian tumor. A case of müllerian adenofibroma of the uterus was studied by light and electron microscopy. Light microscopically, the cleft-like glands lined by single-layered columnar or cuboidal epithelial cells were distributed in the proliferation of surrounding fibroblast-like mesenchymal cells. Mitotic figures of mesenchymal cells were less than 1--2 in 10 high power fields, and no nuclear atypia or heterologous elements were observed. Electron microscopically, the epithelial cells had well-developed mitochondria, r-ERs, tonofilaments in the cytoplasm, and short microbilli or cilia protruding into the lumen. In the mesenchyme, two types of cells were observed. One was spindle-shaped cells resembling fibroblasts, and the other was cells resembling immature smooth muscle cells. The histological and ultrastructural features of müllerian adenofibroma were felt to resemble those of müllerian adenosarcoma, which may pursue a clinically malignant course. These findings suggest that müllerian adenofibroma and adenosarcoma may be in the common spectrum of mixed müllerian tumor.
Adenofibroma↗
Papillary adenofibroma of the cervix: a case report.
Adenofibroma is an extremely rare benign biphasic neoplasm that is classified into the mixed epithelial and mesenchymal tumor group. It typically affects the endometrium, but may occur in the cervix or in an extrauterine location. Preoperative diagnosis of this tumor is usually difficult. We describe the case of a 55-year-old woman with papillary cervical adenofibroma, which appeared as a cervical mass containing multiple cystic components on transvaginal ultrasound. This lesion appears to be clinically and histologically benign but must be differentiated from malignant lesions of the uterus, particularly from adenosarcoma, which can be suggestive of adenofibroma. Accurate diagnosis of these benign tumors permits appropriate counseling of patients.
Adenofibroma↗
Uterine adenofibroma and endometrial stromal sarcoma associated with tamoxifen therapy: MR findings.
Tamoxifen therapy may result in a variety of endometrial proliferative lesions, including adenofibroma and endometrial stromal sarcoma (ESS). This report describes the MR findings of adenofibroma and ESS associated with tamoxifen therapy. When MRI demonstrates a uterine mass appearing as a heterogeneous mass in the endometrium or myometrium, adenofibroma and ECC must be considered as rare, but possible, diagnoses.
Adenofibroma↗
Papillary adenofibroma of the uterus. Report of a case involved by adenocarcinoma and review of the literature.
An unusual case of uterine papillary adenofibroma involved by an invasive well-differentiated adenocarcinoma is reported. The diagnosis was established using a hysterectomy specimen from a 68-year-old woman who was initially examined for abdominal pain and vaginal bleeding. The tumor was a broad-based polypoid mass composed of papillary projections into clefts and cysts. These papillations were covered by a variety of epithelial types and focally involved by an infiltrating adenocarcinoma. The stroma was fibrous and collagenized with variable numbers of benign fibroblasts. The papillary adenofibroma is considered to be a benign mixed tumor of Müllerian origin. Fifteen other cases of uterine adenofibroma have been reported in the literature and only one of these was focally involved by an adenocarcinoma. The clinical and histologic features of this rare disease are reviewed.
Adenocarcinoma↗
Atypical and borderline endometrioid adenofibromas of the ovary. A report of 27 cases.
The significance of varying degrees of epithelial atypicality was investigated in 27 endometrioid adenofibromas and cystadenofibromas of the ovary. The tumors were classified as atypical or borderline on the basis of the degree of atypicality of the epithelial element. All tumors were confined to the ovary at the initial operation and most of them were treated by a hysterectomy and bilateral salpingo-oophorectomy. Seven tumors with mild to severe cytologic and architectural atypicality similar to that encountered in atypical endometrial hyperplasia were classified as atypical adenofibromas. No recurrences or deaths from tumor occurred in patients with this type of tumor during 1-18.5 years of follow-up. Twenty tumors that contained closely packed glands or epithelial islands with a cribriform pattern composed of cells with low-grade malignant nuclear characteristics embedded in an abundant fibromatous stroma without evidence of invasion were classified as borderline. Nineteen patients with tumors of this type had no evidence of disease 1-13 years after initial therapy. One of these tumors was discovered at autopsy. These data, although based on a relatively small series of cases, suggest that atypical endometrioid adenofibromas and those of borderline malignancy have an excellent prognosis.
Adenofibroma↗
Mucinous adenofibromas of the ovary. A report of 10 cases.
Mucinous epithelium is the most uncommon type identified in ovarian adenofibromas. Because of the rarity of mucinous adenofibromas and the presence of cytologic atypia in some, these neoplasms may be mistaken for low-grade metastatic adenocarcinoma. The clinicopathologic features of 10 mucinous adenofibromas are reviewed. They occurred in women 24 to 76 (mean, 51) years of age, were unilateral, and ranged in diameter from 1 to 25 cm. Seven tumors were classified as benign, containing glands lined by a single layer of mucin-containing columnar cells. Three tumors that contained crowded glands lined by mucin-containing cells with mild to moderate nuclear atypia, nuclear stratification of up to three cells in thickness, and focal tufting were classified as benign with epithelial atypia. Most women had a hysterectomy and bilateral salpingo-oophorectomy. Follow-up information was available on six women, who were alive and well from 6 to 126 (mean 41) months after diagnosis. The identification of mucinous glands in typical fibromatous stroma should allow the distinction of these benign neoplasms from metastatic carcinomas.
Adenofibroma↗
Metanephric adenofibroma: report of a case and review of the literature.
The recent recognition of a variety of pediatric renal tumors of different biologic behavior places an ever-increasing demand on the surgical pathologist for an accurate diagnosis. Although metanephric adenofibroma is one of the rarest benign renal tumors, the clinical importance of correctly diagnosing it cannot be overemphasized because it can potentially be mistaken as Wilms' tumor. We describe the clinical, radiologic, and pathologic features of a case of metanephric adenofibroma and discuss its differential diagnosis. The neoplasm was composed of two discrete components: a major fibroblastic element and a minor immature epithelial element. The latter formed a small nodule beneath the renal capsule, which could barely be detected by magnetic resonance imaging. This subcapsular nodule, however, was slightly soft and tan and was distinctly different from the white, whorled cut surface of the main tumor. It was formed by closely packed small immature epithelial cells in a slightly edematous background, which was histologically identical to metanephric adenoma and closely resembled epithelial Wilms' tumor. Unlike Wilms' tumor, however, the epithelial cells were very bland with no mitoses. The main bulk of the tumor was formed by spindle fibroblastic cells that were cytologically similar to the spindle cells in congenital mesoblastic nephroma. The tumor, however, was well demarcated without the irregular infiltrating edges of congenital mesoblastic nephroma. In contrast to the randomly distributed epithelial element throughout the stromal component in previous reported cases of metanephric adenofibroma, our finding of the exceedingly small and discrete epithelial component expands the known histologic spectrum of the disease. In addition, the presence of such minute epithelial nodule underscores the importance of diligent pathologic examination and careful sampling of tissue for histologic examination.
Adenofibroma↗
Biliary adenofibroma: a rare neoplasm of bile duct origin with an indolent behavior.
We report a case of biliary adenofibroma in a 47-year-old woman, who presented with right upper quadrant pain for several months. Abdominal imaging revealed a 16-cm solid and cystic mass in the left hepatic lobe. Histologically, the tumor showed two distinct components: 1) cystic and tubular structures lined by low columnar to cuboidal biliary-type epithelium, and 2) a dense fibrous stroma composed of spindle-shaped cells with only mild nuclear pleomorphism and inconspicuous nucleoli. Mitoses and stromal invasion were absent. The glandular epithelium stained positively for keratin AE.3/Cam 5.2, cytokeratin 7, cytokeratin 19, carcinoembryonic antigen, and epithelial membrane antigen and had a low Ki-67 proliferative index. In addition, the epithelium was positive for D10 but did not stain for 1F6 or acid mucin with alcian blue stain. This staining pattern, similar to bile duct hamartoma (von Meyenburg complex) with which this tumor shares morphologic similarity, suggests that biliary adenofibroma originates from interlobular or larger bile ducts. Three years after a subtotal resection no metastasis or significant tumor growth was noted. However, given the marked nuclear p53 immunoreactivity and tetraploidy status observed in this tumor, we cannot exclude that biliary adenofibroma may represent a premalignant process that warrants complete resection and thorough histopathologic examination.
Adenofibroma↗
Benign clear cell adenofibroma of the ovary. A case report with literature review.
Most clear cell neoplasms of the ovaries are carcinomas; benign and borderline clear cell tumors are uncommon. To date, only 12 cases of benign clear cell adenofibroma have been reported in the literature. Here we report a case of benign clear cell adenofibroma of the left ovary in a 51-year-old postmenopausal woman. Histological examination revealed widely spaced simple glands embedded in a dense fibrous stroma. The glands were lined by one to two layers of cells with abundant clear cytoplasm. The nuclei were bland and uniform in size and shape. There was minimal cytologic atypia in some areas. In this article we discussed the criteria for the diagnosis of benign and borderline clear cell adenofibromas and reviewed the literature.
Adenofibroma↗
Benign and borderline clear cell adenofibromas of the ovary.
The criteria for the diagnosis of benign and borderline clear cell adenofibromas and their biologic behavior were investigated by examination of the clinical and pathologic features of 18 tumors in these categories. Three tumors that showed no significant epithelial atypicality were classified as benign. Twelve tumors that contained glands or small solid nests composed of epithelial cells with nuclear characteristics of low-grade malignancy without invasion of the stromal component of the tumor were designated as borderline. Three predominantly borderline tumors with focal microinvasion of the stromal component were also studied. The 17 patients had nonspecific complaints. Sixteen of the tumors were unilateral without surface involvement; one patient had bilateral borderline tumors. Most of the women were treated by hysterectomy and bilateral salpingo-oophorectomy. Follow-up information was available for 16 of the 17 patients. No recurrences or deaths from tumor occurred in 14 patients (2 benign, 10 borderline, 2 microinvasive). One patient with a borderline adenofibroma had questionable lung metastasis 4 years after presentation, and another patient who had a microinvasive tumor had a pelvic recurrence 3.3 years postoperatively.
Adenofibroma↗
Fine-needle aspiration cytology of endometrioid adenofibroma of the ovary.
We report the fine-needle aspiration (FNA) cytology findings of endometrioid adenofibroma arising in the ovary of a 60-year-old woman who presented with vaginal bleeding. Imaging studies revealed a large pelvic mass, which was sampled by computed tomography-guided FNA and core biopsy. The FNA yielded cellular smears composed of bland endometrioid cells and fragments of ovarian-type stroma. The core biopsy showed a biphasic process comprising bland endometrioid glands in a spindle-cell stroma. Immunohistochemical studies performed on the core showed the stroma to be CD10-negative and smooth muscle actin-positive. Subsequent resection of the tumor confirmed the diagnosis and revealed an adenocarcinoma arising in the tumor that was not sampled by FNA. To our knowledge, the cytologic features of ovarian endometrioid adenofibroma have not been previously described.
Adenofibroma↗