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345 A case of mixed adenocarcinoma of uterus with bladder invasion originating from adenomyosis
  1. A Nakashima,
  2. H Saji,
  3. J Kasuga and
  4. M Suzuki
  1. Fujisawa Municipal Hospital, Japan


Introduction Adenocarcinomas originating from uterine adenomyosis are extremely rare. In addition, mixed adenocarcinoma of uterus with endometrial carcinoma and serous carcinoma is relatively infrequent.

Case Presentation A 52-year-old woman with a chief complaint of hematuria referred to our urology department. Tumor markers were elevated: Cancer antigen (CA) 19–9 58.6U/ml, CA 125 101.5U/ml. Urinary cytology, cervical cytology, and intimal cytology were all adenocarcinoma. Cystoscopy revealed protuberant lesions from posterior wall of the bladder. MRI showed a continuous tumor from anterior wall of the uterine body to the lumen of the posterior bladder, and CT showed an enlarged retroperitoneal lymph node. Transurethral resection of bladder tumor was performed to excise the tumor, which was also diagnosed as adenocarcinoma. A modified radical hysterectomy, bilateral salpingo-oophorectomy, partial cystectomy, lymph node biopsy and omentectomy were performed with urologists. Histologically, invasive carcinomas were found mainly locating in the myometrium and appeared only a few to endometrium. Some tumors were also seen in adenomyosis. Immunostaining resulted in a mixed serous carcinoma with endometrioid carcinoma. The biopsy image of the bladder showed similar findings, which was considered as direct invasion. Adjuvant chemotherapy with cisplatin and doxorubicin is being performed.

Discussion We experienced a rare case of mixed carcinoma of uterus with serous carcinoma and endometrioid carcinoma. She was free of irregular bleeding because the myometrial lesion was the main site of the lesion. Uterine adenomyosis may be involved in the tumor invasion from the uterine to the bladder lumen. Further cases are expected to accumulate.

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