Uterus-like Mass
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The uterus-like mass (ULM) is a tumorlike anatomical entity originally described in the
ovary The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. ...
in 1981 and thereafter reported in several locations of the pelvis and abdominal cavity including
broad ligament The broad ligament of the uterus is the wide fold of peritoneum that connects the sides of the uterus to the walls and floor of the pelvis. Structure Subdivisions Contents The contents of the broad ligament include the following: * Reproduc ...
,
greater omentum The greater omentum (also the great omentum, omentum majus, gastrocolic omentum, epiploon, or, especially in animals, caul) is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature o ...
,
cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
,
small intestine The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...
,
mesentery The mesentery is an organ that attaches the intestines to the posterior abdominal wall in humans and is formed by the double fold of peritoneum. It helps in storing fat and allowing blood vessels, lymphatics, and nerves to supply the intestines ...
and
conus medullaris ''Conus'' is a genus of predatory sea snails, or cone snails, marine gastropod mollusks in the family Conidae.Bouchet, P.; Gofas, S. (2015). Conus Linnaeus, 1758. In: MolluscaBase (2015). Accessed through: World Register of Marine Species at ...
. Basically, it is represented by a miniature
uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...
comprising a
smooth muscle Smooth muscle is an involuntary non-striated muscle, so-called because it has no sarcomeres and therefore no striations (''bands'' or ''stripes''). It is divided into two subgroups, single-unit and multiunit smooth muscle. Within single-unit mus ...
wall lined by
endometrium The endometrium is the inner epithelial layer, along with its mucous membrane, of the mammalian uterus. It has a basal layer and a functional layer: the basal layer contains stem cells which regenerate the functional layer. The functional laye ...
thus outlining a uterus anatomical structure. Some of the reported cases have been associated to
urinary tract The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, con ...
and internal genitalia malformations whereas others appeared as a solitary finding. The term endomyometriosis has also been applied to this lesion. Different
pathogenetic Pathogenesis is the process by which a disease or disorder develops. It can include factors which contribute not only to the onset of the disease or disorder, but also to its progression and maintenance. The word comes from Greek πάθος ''pat ...
views have been suggested for this anomaly: a) a
metaplastic Metaplasticity is a term originally coined by W.C. Abraham and M.F. Bear to refer to the plasticity of synaptic plasticity. Until that time synaptic plasticity had referred to the plastic nature of ''individual'' synapses. However this new form re ...
change in
endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, f ...
foci bringing about smooth muscle
hyperplasia Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferati ...
; b) a
congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...
anomaly due to fusion defects of the
Müllerian ducts Paramesonephric ducts (or Müllerian ducts) are paired ducts of the embryo that run down the lateral sides of the genital ridge and terminate at the sinus tubercle in the primitive urogenital sinus. In the female, they will develop to form the fal ...
; and c) a sub-coelomic transformation of the
mesenchyme Mesenchyme () is a type of loosely organized animal embryonic connective tissue of undifferentiated cells that give rise to most tissues, such as skin, blood or bone. The interactions between mesenchyme and epithelium help to form nearly every o ...
. ULM has also been reported associated to
endometrial carcinoma Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb). It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most o ...
and
breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...
. A clonal chromosome deletion 2p21 was found in endomyometriosis by Verhest et al. while Pai evidenced a strict relationship among ULM,
breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...
and elevated serum CA125 supporting the view of ULM being either hormone-dependent or a form of
endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, f ...
. There have been reports of the finding of occurrence of endometriosis in leiomyomatosis peritonealis disseminata. More than 15 cases of ULM have been reported so far. A case of ULM was reported 22 years after total
hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...
, another 17 years after. Abdominal pain and a palpable mass are among the main clinical findings. Anyway, the phenomenon of smooth muscle cell
metaplasia Metaplasia ( gr, "change in form") is the transformation of one differentiated cell type to another differentiated cell type. The change from one type of cell to another may be part of a normal maturation process, or caused by some sort of abno ...
occurring in association with endometriosis (endomyometriosis), as well as of smooth muscle differentiation at endometrio-myometrial junction independently from actually engendering uterus-like configurations in several locations of the pelvis, have been pointed out by several authors. A
magnetic resonance Magnetic resonance is a process by which a physical excitation (resonance) is set up via magnetism. This process was used to develop magnetic resonance imaging and Nuclear magnetic resonance spectroscopy technology. It is also being used to ...
account of this lesion type has been provided by Menn et al.Menn KA, Qin L, Fedoriw G, Gillette ME, McCarthy S (2007). Uterus-like mass: MRI appearance of a very rare entity. JMRI 26(1):162-164.


Sources


Further reading

* Kaeser SA, Ruchti C, Frankhauser G (2008). Uterus-like mass in the great omentum. Geb Frauenh 68(1):88-90. * {{cite journal , author1=Kaufman Y , author2=Lam A , title=The pelvic uterus-like mass - A primary or secondary Muellerian system anomaly? , journal=Journal of Minimally Invasive Gynecology , date=2008 , issue=15 , pages=494-497 * Khurana A, Mehta A, Sardana M (2011). Extrauterine adenomyoma with uterus-like features. A rare entity presenting 17 years post hysterectomy. Indian J Pathol Microbiol 54:572-573. * Peterson CJ, Strickler JG, Gonzalez R, Dehner LP (1990). Uterus-like mass of the small intestine. Heterotopia or monodermal teratoma? Am J Surg Pathol 14(4):390-394. * Pueblitz-Peredo S, Luévano-Flores E, Rincòn-Taracena R, Ochoa-Carrillo FJ (1985). Uterus-like mass of the ovary: endometriosis or congenital malformation? A case with discussion of histogenesis. Arch Pathol Lab Med 109:361-364. * Rahilly MA, Al-Nafussi A (1991). Uterus-like mass of the ovary associated with endometrioid carcinoma. Histopathology 18:549-551. * Redman R, Wilkinson EJ, Massoll NA (2005). Uterine-like mass with features of an extrauterine adenomyoma presenting 22 years after total abdominal hysterectomy - bilateral salpingo-oophorectomy: A case report and review of the literature. Arch Pathol Lab Med 129(8):1041-1043. Uterus