Uterine papillary cystadenoma of wolffian body origin

TJTERINE

PAPILLARY

CYSTADENOMA ORIGIN

OF WOLFFIAN

BODY

CHARLES C. WEITZMAN, M.D., FREDERICK SHEER, M.D., AND SILIK H. POLAYES, M.D., BROOKLYN, N. Y. (From

the Department

of Pathology,

CumberEa+ad

Street

Hospital)

4

SURVEY of the literature of the last twenty-five years reveals ,a prodigious number of articles under the headings of i ‘adenomyoma” and “adeaomyosis” of the uterus, but few cases, if any, of true papillary cystadenoma of the uterus have been described as such. C. J., Porto Rican, thirty-eight years of age, married for fourteen years, was admitted to the Cumberland Hospital of Brooklyn on March, 1935, complaining of a mass in the lower abdomen for two years. She had no pain or other associated symptoms and was normal in every respect. Menstruation began at the age of fourteen. She was menstruating at the time of admission to the hospital and her last normal 1

Fig.

l.-Gross

specimen

showing

tumor uterus

(A)

situ&xl

in

the

upper

portion

of

the

(B).

period occurred a month previously. She had one pregnancy which ended in a spontaneous miscarriage (date unknown). Abdominal examination revealed a movable mass, about 9 by 12 cm., in the lower abdomen, arising from the pelvis, which by bimanual examination was apparently part of the uterus. No tenderness was noted in either the region of the mass or the uterus. The cervix was in the vaginal axis and the adnexa were not felt. The blood Wassermann and the Aschheim-Zondek tests were negative. Preoperahe diagnosis: Fibromyoma uteri. Operative diagnosis : Fibromyoma uteri and chronic bilateral tuboovarian disease. Operation : Supraeervical hysterectomy, bilateral salpingo-oophorectomy. The wound healed by primary union and the patient made an uneventful recovery. PATHOLOGIC

was cm.

REPORT

(Fig. 1.) Consisted of uterus smooth and ovoid in shape, soft in consistency, in length, 7.5 cm. in width, and 5.5 cm. in

Gross

specimen:

S76

and adnexa. The uterine and the uterus measured anteroposterior diameter.

wall 10.5

The

876

Fig.

ANERICAN

2.- -Section

Fig. tubules appears

through

JOURNAL

the

OF

tumor character

OBSTEsTRICS

proper, showing of the growth.

3.-Section through the interstitial (a) along the course of the fallopian in the section.

portion tube,

XXD

the

GYNECOLOGY

papillary

of the right part of the

cystadenomal

tube. lumen

:OUS

Xote wol Ran CR) of which

WEITZMAN

ET

AL.

:

UTERINE

PAPILLARY

CYSTADENOYA

specimen was opened from the right lateral surface. The endometrial cavity found to be a narrow, crescentic slit which extended to a height of 3 cm. the lower pole. The cavity could be traced to the left tube, but on the right j.t was lost and its continuity could not be established with the right tube.

877

was from side

An intramural, pale pink, cystic, trabeculated mass 5 by 6 by 4 cm. occupied the greater portion of the uterine body and fundus, and contained a large number Iof discrete cystic structures of varying size which were mucoid in appearance and were filled with a clear colorless fluid. The main wall was completely surrounded lby myometrium and merged imperceptibly with it. The tubes were thickened, cystic, and retort-shaped. The fimbriated ends were sealed. On section, the tubal lumina were found to contain a viscid, chocolatecolored content. The ovaries were small, intimately adherent to the tubes, and on section presented a sclerotic appearance, with several small follicular cysts, and hyalinized corpora albicantes.

M&~oscopic: (Figs. 2 and 3.) The tumor was composed of interlacing cystic and papillary structures which were lined by epithelium, varying from low cuboidal it0 tall columnar, both ciliated and nonciliated cells, and supported by a stroma of muscle and connective tissue, but nowhere in the stroma could endometrium be demonstrated. Serial sections failed to establish continuity between the newgrowth and the endometrium. Sections through the interstitial portion of the right tube :and including a small area of the cystic mass disclosed the interstitial portion of the tube, and there were in its vicinity numerous ducts and glandlike structures, varying in size and shape. They were lined by cells which were both ciliated and nonciliated and which varied from low cuboidal to tall columnar, directly imbedded in the .musele tissue of the uterus, with no communication with the tubal lumen. These structures were histologically recognized as epoophoron-like (wolffian body rests). A number of these ducts and glandlike structures were cystic, some were papillated land showed a striking similarity to the histologic picture of the uterine intramural newgrowth described above. The tubal walls presented a chronic inflammatory -process. Sections of. the ovary showed a chronic oophoritis and several follicular cysts. DISCUSSION

AND

CONCLUSION

In the opinion of the authors, this tumor is probably of wolffian body origin. YNotwithstanding Cullen:s view that one cannot differentiate from the histologic Ipicture a wolffian or miillerian origin of intramural cysts, the histologic picture ‘of this newgrowth is apparently not of endometrial or tubal origin as evidenced by (a) the failure to trace continuity to either of these structures by serial sections as well as by (b) the absence of endometrial stroma in the tumor. On the contrary, ,the histologic picture of the newgrowth more closely simulates that of the epoophoron (wolffian body rests). This is in conformity with the observation of Ivanov, whose work shows the part played by the wolffian body in the formation of -the uterine wall. Mercade has demonstrated that the location of these wolffian body rests may be at the cornua, in the fundus, or along the lateral wall of the uterus. The structure and location of the mass in this case therefore may be ‘considered a papillary cystadenoma of wolffian body origin and as such should be recognized as distinct from the adenomyomas of heterologous origin. 847 EASTERN PAREWAY 1325 EAST NINTH STREET