Adenomatoid tumors of the uterus are uncommon benign lesions derived from mesothelium, with a prevalence of 1.2% in one study of 1 000 unselected
hysterectomy specimens. They are usually small and near the serosal surface; however, they may be large and diffuse (giant
adenomatoid tumors). They coexist with
leiomyomas in 60% of cases. A 33-year-old nulliparous woman was referred for severe
menorrhagia and
dysmenorrhea, thought to be due to a submucosal
fibroid on ultrasound. This transpired to be an
adenomatoid tumor, and she underwent three transcervical resections of the
tumor (TCRT) over a period of 12 months for
tumor recurrence and failure of symptom resolution. The last TCRT was performed with ultrasound guidance and laparoscopic visualization of the uterus to the resection point of blanching of the serosal surface. She failed to respond to a
GnRH analogue throughout. A specialist opinion on the suitability of vascular embolization of the
tumor judged that it would be ineffective for this lesion. She then underwent a Strassman procedure and removal of the
adenomatoid tumor. This involved dissection of ureters and pelvic vasculature, selective temporary
ligation of uterine arteries, hemisection of the uterus, and excision of the
tumor with frozen sections to ensure clear
tumor margins and resuturing of the uterine halves. Temporary vascular occlusion of the uterine arteries and ovarian vessels allowed a Strassman procedure, which resulted in successful resection of a recurrent giant
adenomatoid tumor of the uterus, with fertility preservation in a young nulliparous woman. Two and a half years on there is no evidence of
tumor recurrence.