Ultrasound Obstet Gynecol 2005; 26: 186–187
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.1948
Papillary adenofibroma of the cervix: a case report
A. HABERAL, A. P. CIL, M. GUNES and D. CAVUSOGLU
SSK Maternity and Health Teaching Hospital, Gynecology, Ankara, Turkey
KEYWORDS: adenofibroma; adenosarcoma; cervical tumor; differential diagnosis; endometrial tumor; uterine tumor
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
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.
Copyright 2005 ISUOG. Published by John Wiley &
A 55-year-old woman presented with irregular vaginal
bleedingthathad lastedfor2 monthscausinganemiawith
a hemoglobin level of 7.7 mg/dL. On pelvic examination,
a 6-cm cervical mass that bled when palpated was
noted. Transvaginal ultrasonography revealed a 6 × 7-
cm cervical mass containing small cysts (Figure 1) but a
normal uterus and adnexa. Histological analysis of the
cervical biopsy specimen suggested cervical polyp, which
a laparotomy was planned to reveal the true nature of the
At laparotomy, examination of the pelvis revealed a
normal-sized uterus with a 6 × 7-cm cervical mass, which
formed a barrel-shaped cervix. Subtotal hysterectomy
with bilateral salpingoophorectomy was performed and
a small piece of the cervical mass was sent for frozen
section. Histological examination of the frozen section
Figure 1 Transvaginal sonography showing a cervical mass
containing multiple irregular cysts.
of the specimen revealed adenofibroma. The cervical
mass was then extirpated during the operation, which
was extended to total abdominal hysterectomy. The
macroscopic appearance of the surgical specimen was a
epithelial and mesenchymal components. Postoperative
pathological examination revealed an adenofibroma of
the cervix (Figure 2) extending to the anterior lower wall
of the uterus, and an endometrial polyp.
Cervical adenofibroma was first reported by Abell in
19711and accounts for 10% of uterine adenofibromas,
with most tumors arising in the endometrium2. Ade-
nofibromas can be seen in patients of any age, but they
occur most frequently in peri- or postmenopausal women.
Abnormal vaginal bleeding is the most frequent com-
plaint. Some patients have a history of prior removal of
polyps and, in our patient, an endometrial polyp was
Correspondence to: Dr A. P. Cil, SSK Maternity and Health Teaching Hospital, Gynecology, Ankara, Turkey (e-mail: email@example.com;
Accepted: 19 January 2005
Copyright 2005 ISUOG. Published by John Wiley & Sons, Ltd.CASE REPORT
Papillary adenofibroma of the cervix
Figure 2 Photomicrograph showing cervical adenofibroma
composed of papillary processes.
diagnosed after surgery3. Hysterectomy is the preferred
treatment for an adenofibroma because the neoplasm may
recur if it is incompletely curretted or excised4.
It is clinically important to distinguish adenofibromas
from adenosarcomas. The hypercellular periglandular
stroma that characterizes adenosarcoma is not present
in adenofibromas. Stromal cell atypia is generally absent
or mild and markedly atypical mesenchymal cells are not
present. Mitotic figures are rare. There are invariably
fewer than four mitotic figures per 10 high-power
field (4MF/10HPF), and some regard the presence of
virtually any detectable mitotic activity as indicative of
There are a few reports in which the sonographic
appearance of endometrial adenofibroma was described
as echogenic intracavitary masses containing multiple
irregular cysts with distinct margins5,6. The ultrasound
findings in our case were consistent with this except for
the location (Figure 1).
In this case, the main concern was the differential
diagnosis of the cervical lesion from cervical cancer.
Although the transvaginal ultrasound appearance was
one we had never seen before, pelvic examination and
histological examination of the cervical biopsy were
inconsistent with cervical cancer, so we opted to send
a specimen for frozen section before deciding which type
of hysterectomy to perform.
The sonographic finding of adenofibroma, which is an
unusual type ofuterine tumor,must be differentiatedfrom
hyperplasia and molar pregnancy when located in the
endometrium, and from cervical carcinoma when located
in the cervix. It must be borne in mind that, uterine lesions
that appear as intracavitary or cervical masses containing
multiple irregular cystic components on ultrasound and
no clinical evidence of malignancy may be benign uterine
adenofibroma and these lesions must be considered in the
differential diagnosis of abnormal vaginal bleeding.
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Copyright 2005 ISUOG. Published by John Wiley & Sons, Ltd.
Ultrasound Obstet Gynecol 2005; 26: 186–187.