Uterine adenosarcoma detected by Papanicolaou smear: a case report

Uterine Adenosarcoma: a Review

Adenosarcomas are rare malignancies of the female genital tract, accounting for approximately 5 % of uterine sarcomas. Occasionally, adenosarcoma occurs in the ovaries or in extra-uterine tissue, which may be related to endometriosis. These tumors are characterized by benign epithelial elements and a malignant mesenchymal component. Pathologic diagnosis is dependent on the identification of the characteristic morphologic features. The most common immunohistochemical markers for adenosarcoma are CD10 and WT1, but these are not specific. The most frequent presenting symptom is abnormal uterine bleeding. The majority of patients present with stage I disease, with a 5-year overall survival of 60 to 80 %. Survival is influenced by the presence of myometrial invasion, sarcomatous overgrowth, lymphovascular invasion, necrosis, and the presence of heterologous elements including rhabdomyoblastic differentiation. Patients with sarcomatous overgrowth have significantly increased risk of recurrence 23 versus 77 % and decreased 5-year overall survival 50 to 60 %. Standard of care treatment is total hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy, as the incidence of lymph node metastasis is rare. Retrospective data does not support the use of adjuvant pelvic radiotherapy in uterine adenosarcomas as no survival benefit is seen. Insufficient data exists to recommend routinely neoadjuvant or adjuvant chemotherapy for uterine adenosarcomas. Limited evidence exists for the role of hormonal therapy in uterine adenosarcomas. The PIK3/AKT/PTEN pathway is mutated in ∼70 % of adenosarcomas, and this may represent a possible therapeutic target. This article reviews the current state of knowledge concerning uterine adenosarcoma and discusses the management of this rare tumor.

Uterine adenosarcoma detected by conventional papanicolaou smear: A case report with emphasis on integrating the immunocytochemical staining

Adenosarcoma is a rare uterine malignant tumor composed of benign to atypical epithelial element and a usually low-grade sarcomatous component. Although it is well known histologically, its cytological features are rarely described in the literature. We report a case of uterine adenosarcoma being the first one that was accurately diagnosed before operation by the conventional Papanicolaou (Pap) smear with emphasis on the contribution of the integrated immunocytochemical staining. A 46-year-old woman with abnormal vaginal bleeding and a protruding mass from her cervical os. Her Pap smear revealed: (a) presence of endometrial necrotic debris in the background, which indicated the presence of an endometrial lesion, (b) presence of both abnormal endometrial glandular cells (compact and tight clusters with slight hyperchromasia, increased nucleus/cytoplasm (N/C) ratio, apparent nucleoli and moderate vimentin stain) and abnormal stromal cells (loose aggregates of spindle to polygonal cells with hyperchromasia, increased N/C ratio and very strong vimentin staining). The characteristic degenerative necrotic debris indicating endometrial lesion plus the application of immunocytochemistry, which can increase the detection rate of endometrial lesion by the Pap smears. Awareness of the cytological findings of adenosarcoma can aid to make a correct preoperative diagnosis of this rare disease.