The incidence of cancer from adenomyosis is rare. Previously, only two cases of clear cell adenocarcinoma (CCA) arising from adenomyosis have been reported in English literature. Here, we report a case of CCA arising from adenomyosis. A 52-year-old postmenopausal Korean woman presented with complaints of vaginal bleeding and back pain. Endometrial biopsy revealed endometrial polyp with atrophic change and transvaginal ultrasonography showed myomas with cystic change. Magnetic resonance imaging revealed a cystic degenerative mass consistent with leiomyoma in the posterior portion of uterus body. And the serum level of CA-125 was 17.7 U/mL. Hysterectomy revealed a yellow-ten solid mass in the myometrium that was diagnosed as CCA arising from adenomyosis. The tumor was mainly located in the myometrium and transition between adenomyosis and CCA along with endometrial stromal cell was identifi ed. Malignant tumor arising from adenomyosis could be considered as a differential diagnosis when the patient with adenomyosis and intact endometrial surface complained of vaginal bleeding.

ObjectiveThe aim of this study is to assess the risk of adverse pregnancy outcome by maternal serum markers in Quad test and to compare the existing cutoff (2.0 MoM) with 95 percentile cutoff generated from our consecutive population in predicting adverse pregnancy outcome. MethodsWe generated 95 percentile cutoff as our own reference using 3,000 consecutive women who performed Quad test. Except for follow-up loss, fetal aneuploidy and anomaly, 2,598 women were analyzed for the assessment of adverse pregnancy outcome consisted of preeclampsia (PE), preterm birth (<32 weeks), low birth weight and fetal death in utero. ResultsWe confirmed high levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and inhibin A are associated with development of PE, preterm birth, and low birth weight. In general, 95 percentile cutoff corresponded similarly with 2.0 MoM except AFP. Combination of serum markers increased the odds ratio for predicting adverse pregnancy outcome. The women with higher level of both AFP and inhibin A (2.0 ≥ MoM) had 9.8 times higher risk for PE, 24.8 times higher risk for preterm birth, and 5.6 times higher risk for low birth weight. The women with higher level of AFP, hCG, and inhibin A had 8.2 times higher risk for PE, 29.4 times higher risk for preterm birth. Notably, negative predictive value of serum markers for PE and preterm birth are over 98% either in alone and in combination. ConclusionMaternal serum makers either in alone and in combination offer valuable information on the risk assessment of adverse pregnancy outcome.

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