_______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 2018 Jun 20; 6(6):1091-1094. 1091 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2018 Jun 20; 6(6):1091-1094. https://doi.org/10.3889/oamjms.2018.239 eISSN: 1857-9655 Case Report Endometrioid Adenocarcinoma Arising in Adenomyoma in a Woman with a Genital Prolapse - Case Report Vesna S. Antovska 1 , Iskra Krstevska 1 , Milka Trajanova 1 , Jasmina Chelebieva 1* , Irena Gosheva 1 , Pance Zdravkovski 2 , Slavica Kostadinova-Kunovska 2 , Vesna Janevska 2 1 University Clinic for Gynecology and Obstetrics, Department for Urogynaecology and Pelvic Floor Disorders, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia; 2 Institute of Pathology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia Citation: Antovska VS, Krstevska I, Trajanova M, Chelebieva J, Gosheva I, Zdravkovski P, Kostadinova- Kunovska S, Janevska V. Endometrioid Adenocarcinoma Arising in Adenomyoma in a Woman with a Genital Prolapse-Case Report. Open Access Maced J Med Sci. 2018 Jun 20; 6(6):1091-1094. https://doi.org/10.3889/oamjms.2018.239 Keywords: Endometrial cancer; Uterine leiomyoma; Genital prolapse *Correspondence: Jasmina Chelebieva. University Clinic for Gynecology and Obstetrics, Department for Urogynaecology and Pelvic Floor Disorders, Skopje, Republic of Macedonia. E-mail: jasmina_medicine2006@hotmail.com Received: 14-May-2018; Revised: 23-May-2018; Accepted: 30-May-2018; Online first: 14-Jun-2018 Copyright: © 2018 Vesna S. Antovska, Iskra Krstevska, Milka Trajanova, Jasmina Chelebieva, Irena Gosheva, Pance Zdravkovski, Slavica Kostadinova-Kunovska, Vesna Janevska. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Abstract BACKGROUND: Endometrial cancer is the third-ranked genital malignancy in women and includes 3% of cancer deaths. There is a 2.8% chance of a woman developing endometrial cancer during her lifetime. Low-grade endometrioid adenocarcinomas are often seen along with endometrial hyperplasia, but high-grade endometrioid adenocarcinomas have more solid sheets of less-differentiated tumour cells, which are no longer organised into glands, often associated with surrounded atrophic endometrium. CASE REPORT: We present an unusual case of endometrial adenocarcinoma arising in adenomyoma in 74-year old woman presented with genital prolapse, without other clinical symptoms. Ultrasound evaluation revealed endometrium with 4 mm-thickness and atrophic ovaries. The cervical smear was normal. The patient underwent a total vaginal hysterectomy. The histopathology of the anterior uterine wall revealed an intramural adenomyoma of 4 mm in which some endometrial glands with malignant transformation of well-differentiated endometrioid adenocarcinoma without infiltration in surrounding myometrium and lymphovascular invasion were present. The endometrium lining the uterine cavity was predominantly atrophic, and only one focus of simplex and complex hyperplasia was found, with cell-atypia. According to AJCC/FIGO 2010, the tumour was classified: pTNM = pT1B pNX pMX G1 R0 L0 V0 NG1, Stage I. On dismiss, the near-future oncological consultation was recommended. CONCLUSION: We would like to point out the rare occurrence of such type of malignancy and the importance of meticulous histopathology evaluation, even after reconstructive surgery for genital prolapse. Introduction Endometrial cancer is the third-ranked genital malignancy in women after cervical and ovarian cancer and accounted for 3% of all cancer deaths in women. Endometrial adenocarcinoma occurs mostly in the postmenopausal age. There is a 2.8% chance of a woman developing endometrial cancer during her lifetime. The cancer cells in endometrioid adenocarcinoma grow in patterns evocative of normal endometrium, with new glands arising from columnar epithelium with some abnormal nuclei. Low-grade endometrioid adenocarcinomas are often seen along with endometrial hyperplasia and most often do not invade the myometrium. Higher-grade endometrioid adenocarcinomas are characterised with less well- differentiated cells and have more solid sheets of tumour cells no longer organised into glands, and are associated with an atrophied endometrium. Smooth muscle tumors of the uterus consist of a broad family of tumors. Leiomyomas are the most common gynaecological neoplasm. In this case, we had an unusual case of endometrial adenocarcinoma arising in adenomyoma. Leiomyoma combined with focal adenocarcinoma of the endometrium is the only rare published article found after the persistent search for the same.