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Uterine adenosarcoma arising from a subserosal adenomyoma: A case report. Gynecol Oncol Rep 2022; 40:100957. [PMID: 35284611 PMCID: PMC8914540 DOI: 10.1016/j.gore.2022.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 11/23/2022] Open
Abstract
Adenosarcoma is a rare tumor of the uterus and cervix occuring mostly in post-menopausal women. Our patient was a 37-year old nullipara presenting with lower abdominal pain and backache. She was diagnosed as a case of multiple leiomyomata and proceeded for myomectomy. Intraoperative findings raised suspicion of malignancy. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology confirmed the diagnosis.
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Ribeiro E Ribeiro R, Lewin ER, Hart JL, Quddus MR, Hansen K. Primary Fallopian Tube Mullerian Adenosarcoma With Sarcomatous Overgrowth and a Previously Unreported MEIS1-NCOA2 Gene Fusion. Int J Gynecol Pathol 2022; 41:82-85. [PMID: 33770059 DOI: 10.1097/pgp.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extrauterine Mullerian adenosarcomas (MA) are rare and often associated with endometriosis. We report a 55-yr-old patient seen in consultation for abdominal pain and bloating. Imaging was suggestive of a left adnexal mass and "peritoneal carcinomatosis". Pathological examination of the specimen revealed a MA arising in the left fallopian tube, with sarcomatous overgrowth, diffuse peritoneal involvement and omental "caking". Next-generation sequencing identified a MEIS1-NCOA2 gene fusion, previously unreported in MA.
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Uterine Adenosarcoma Originating in Adenomyosis: Report of an Extremely Rare Phenomenon and Review of Published Literature. Int J Gynecol Pathol 2021; 40:342-348. [PMID: 32947330 DOI: 10.1097/pgp.0000000000000709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Müllerian adenosarcoma is an uncommon biphasic malignant tumor most often occurring in the uterine corpus and derived from native surface endometrium. We report a case of intramural uterine adenosarcoma arising in association with adenomyosis, in the absence of tumor involving the surface endometrium. This is an extremely rare phenomenon, with only 8 other published cases of uterine corpus adenosarcoma in the absence of surface endometrial involvement, 5 originating in adenomyosis and 3 in adenomyomas. We review these cases. The current FIGO staging system for uterine adenosarcoma assumes origin from the surface endometrium and does not address the rare occurrence of intramural tumors without a surface endometrial component. Such tumors are problematic to stage and could potentially be overtreated, particularly if there is deep myometrial involvement.
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Mandato VD, Torricelli F, Mastrofilippo V, Valli R, Aguzzoli L, La Sala GB. Primary extra-uterine and extra-ovarian mullerian adenosarcoma: case report and literature review. BMC Cancer 2018; 18:134. [PMID: 29402239 PMCID: PMC5800024 DOI: 10.1186/s12885-018-4037-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extra-uterine mullerian adenosarcomas have varying biological behaviours depending on the presence of endometriosis or sarcomatous overgrowth. These behaviours manifest according to the tumours' histological characteristics and sites of origin. The best treatment and oncologic outcome have not been clarified because only a few cases of extra-uterine and extra-ovarian adenosarcoma have been described in the literature. Here, we report a case of primary peritoneal adenosarcoma with sarcomatous overgrowth and review all reported cases of adenosarcomas arising outside of the uterus and outside the ovaries to identify the best treatment options and clarify outcomes. CASE PRESENTATION A 79-year-old woman was referred to our Department with an abdominal mass resembling a fibroid with a haemorrhage. Her gynaecological history was negative. A transvaginal and transabdominal ultrasound examination revealed a multicystic mass resembling an ovarian tumour arising from the pelvis and extending up to the abdomen. At laparotomy a peritoneal mass arising from Douglas peritoneum was resected. The uterus and adnexa appeared normal, and a supra-cervical hysterectomy with bilateral salpingo-oophorectomy was performed. No macroscopic residual disease was present. Final pathology diagnosed a malignant peripheral nerve sheath tumors with divergent differentiation. Four weeks later a new, multicystic mass was found. Due to the progressive poor condition, the patient died four months after diagnosis. Histological slides were reviewed by external expert pathologists and the final diagnosis was of extra-genital adenosarcoma with sarcomatous overgrowth. Furthermore, we also collected and analysed articles written in English regarding extra-uterine and extra-ovarian adenosarcomas published between January 1974 and October 2016. PubMed was used as a database for this search. Clinical and pathological characteristics, treatments and outcomes were assessed. CONCLUSIONS Only 41 cases has been reported in literature. Previous endometriosis and sarcomatous overgrowth showed an inverse effect on prognosis. Endometriosis was confirmed to have a positive effect on disease free survival Complete surgical resection is the mainstay of treatment. A worldwide registry is urgently required to collect data to standardize treatment and to obtain reliable data on prognosis.
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Affiliation(s)
- Vincenzo Dario Mandato
- Unit of Obstetrics and Gynecology, IRCCS- Azienda Unità Sanitaria Locale, Viale Risorgimento n 80, Reggio Emilia, Italy
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale, IRCCS, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale, IRCCS, Reggio Emilia, Italy
| | - Riccardo Valli
- Unit of Pathology, Azienda Unità Sanitaria Locale, IRCCS, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale, IRCCS, Reggio Emilia, Italy
| | - Giovanni Battista La Sala
- Unit of Obstetrics and Gynecology, IRCCS- Azienda Unità Sanitaria Locale, Viale Risorgimento n 80, Reggio Emilia, Italy
- Unit of Obstetrics and Gynecology, University of Modena e Reggio Emilia, Reggio Emilia, Italy
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Lee SJ, Park JY. A Rare Case of Intramural Müllerian Adenosarcoma Arising from Adenomyosis of the Uterus. J Pathol Transl Med 2017; 51:433-440. [PMID: 28741605 PMCID: PMC5525044 DOI: 10.4132/jptm.2017.06.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 06/07/2017] [Accepted: 06/11/2017] [Indexed: 11/28/2022] Open
Abstract
Müllerian adenosarcomas usually arise as polypoid masses in the endometrium of post-menopausal women. Occasionally, these tumors arise in the cervix, vagina, broad and round ligaments, ovaries and rarely in extragenital sites; these cases are generally associated with endometriosis. We experienced a rare case of extraendometrial, intramural adenosarcoma arising in a patient with adenomyosis. A 40-year-old woman presented with sudden-onset suprapubic pain. The imaging findings suggested leiomyoma with cystic degeneration in the uterine fundus. An ill-defined ovoid tumor with hemorrhagic degeneration, measuring 7.5 cm in diameter, was detected. The microscopic findings showed glandular cells without atypia and a sarcomatous component with pleomorphism and high mitotic rates. There was no evidence of endometrial origin. To recognize that adenosarcoma can, although rarely, arise from adenomyosis is important to avoid overstaging and inappropriate treatment.
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Affiliation(s)
- Sun-Jae Lee
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ji Y Park
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
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Yuan CT, Huang WC, Lee CH, Lin MC, Lee CH, Kao YC, Huang HY, Kuo KT, Lee JC. Comprehensive screening forMED12mutations in gynaecological mesenchymal tumours identified morphologically distinctive mixed epithelial and stromal tumours. Histopathology 2017; 70:954-965. [DOI: 10.1111/his.13156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/19/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Chang-Tsu Yuan
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
| | - Wen-Chih Huang
- Department of Pathology; Far-Eastern Memorial Hospital; New Taipei City Taiwan
| | - Cheng-Han Lee
- Department of Pathology; British Columbia Cancer Agency; Vancouver British Columbia
- University of Alberta; Edmonton Alberta Canada
| | - Ming-Chieh Lin
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
| | - Chen-Hui Lee
- Department of Pathology and Laboratory Medicine; Taichung Veterans General Hospital; Taichung Taiwan
| | - Yu-Chien Kao
- Department of Pathology; Shuang Ho Hospital; Taipei Medical University; Taipei Taiwan
| | - Hsuan-Ying Huang
- Department of Pathology; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Kuan-Ting Kuo
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
| | - Jen-Chieh Lee
- Department and Graduate Institute of Pathology; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
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Machida H, Nathenson MJ, Takiuchi T, Adams CL, Garcia-Sayre J, Matsuo K. Significance of lymph node metastasis on survival of women with uterine adenosarcoma. Gynecol Oncol 2017; 144:524-530. [PMID: 28109626 DOI: 10.1016/j.ygyno.2017.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Uterine adenosarcoma (UAS) is a rare gynecologic malignancy and the significance of lymph node metastasis on survival has not been well studied. METHODS A retrospective study was performed utilizing the Surveillance, Epidemiology, End Results Program to examine UAS (n=994), endometrial stromal sarcoma (ESS, n=2910), and uterine leiomyosarcoma (LMS, n=5506) diagnosed between 1973 and 2013. The impact of lymph node metastasis on cause-specific survival (CSS) was cross-compared by multivariable analysis. Systematic literature review was conducted to examine the impact of nodal metastasis on progression-free survival (PFS) in UAS. RESULTS UAS had the lowest incidence of lymph node metastasis among the sarcoma subtypes examined (UAS 2.9%, LMS 3.4%, and ESS 6.6%, P<0.001). Lymph node metastasis was independently associated with decreased CSS in all three tumor types (all, P<0.01); however, magnitudes of statistical significance of lymph node metastasis for CSS were similar across the three tumor types: adjusted-hazard ratio (aHR) for UAS 2.34, ESS 2.43, and LMS 2.10. Systematic literature review identified 230 unique cases of surgically treated UAS. On multivariable analysis, lymph node metastasis (aHR 4.72) had the greatest degree of significance for PFS compared to other tumor factors including sarcomatous overgrowth (aHR 2.88), heterologous elements (aHR 2.08), and deep myometrial invasion (aHR 1.51). Large tumor, deep myometrial invasion, and sarcomatous overgrowth were associated with increased risk of lymph node metastasis (all, P<0.05). CONCLUSION While uterine adenosarcoma had a low incidence of lymph node metastasis, the impact of lymph node metastasis on survival was comparable to ESS or LMS.
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Affiliation(s)
- Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90089, USA
| | - Michael J Nathenson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
| | - Tsuyoshi Takiuchi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90089, USA
| | - Crystal L Adams
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90089, USA
| | - Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90089, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90089, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA.
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Abstract
Müllerian adenosarcoma is an uncommon biphasic tumor composed of malignant stromal and benign epithelial components. Morphologically, adenosarcoma is characterized by a broad leaflike architecture, reminiscent of phyllodes tumors of the breast. Periglandular cuffing of the stromal cells around the compressed or cystically dilated glands is characteristic. The mesenchymal component is typically a low-grade spindle cell sarcoma, whereas the epithelial counterpart is commonly endometrioid with frequent squamous or mucinous metaplasia and may, in some circumstances, show mild to moderate atypia. In all cases, it is important to assess for the presence of sarcomatous overgrowth and myometrial invasion, which are the prognostic factors. In this brief review, we present the clinical, histopathologic, and immunohistochemical features of adenosarcoma, as well as updates on the molecular biology of this neoplasm.
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Affiliation(s)
- Andre Pinto
- From the Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Drs Pinto and Howitt)
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McCluggage WG. A practical approach to the diagnosis of mixed epithelial and mesenchymal tumours of the uterus. Mod Pathol 2016; 29 Suppl 1:S78-91. [PMID: 26715175 DOI: 10.1038/modpathol.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/05/2015] [Indexed: 01/29/2023]
Abstract
The current 2014 World Health Organization (WHO) Classification of mixed epithelial and mesenchymal tumours of the uterus includes categories of carcinosarcoma, adenosarcoma, adenofibroma, adenomyoma and atypical polypoid adenomyoma, the last two lesions being composed of an admixture of benign epithelial and mesenchymal elements with a prominent smooth muscle component. In this review, each of these categories of uterine neoplasm is covered with an emphasis on practical tips for the surgical pathologist and new developments. In particular, helpful clues in the distinction between carcinosarcoma and dedifferentiated endometrial carcinoma will be discussed. In addition, salient features to help distinguish between adenofibroma, adenosarcoma, embryonal rhabdomyosarcoma and other mesenchymal neoplasms in the differential diagnosis will be outlined. Finally, a discussion of adenomyoma and its main differential diagnostic considerations will be covered.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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Elshafie M, Rahimi S, Ganesan R, Hirschowitz L. Müllerian Adenosarcoma Arising in a Subserosal Adenomyoma. Int J Surg Pathol 2012; 21:186-9. [DOI: 10.1177/1066896912453852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Müllerian adenosarcomas most commonly arise in the uterine corpus from the eutopic endometrium. Occasionally, they arise in the cervix, vagina, broad and round ligaments, and ovaries and rarely in extragenital sites, usually in association with endometriosis. The authors report a rare case of extraendometrial, intramural adenosarcoma of low grade arising from a subserosal adenomyoma in a 46-year-old woman who presented with vaginal bleeding. No evidence of eutopic endometrial origin was identified; the adenosarcoma showed only limited myometrial invasion and no serosal involvement. Because of its subserosal location, the tumor would be overstaged as IC (deeply myoinvasive) in the new FIGO staging system. Stage IC tumors would normally be considered for adjuvant treatment, which would be inappropriate in this case. To avoid overstaging and inappropriate treatment, it is important to recognize that adenosarcoma can, rarely, arise in adenomyomas (or adenomyosis).
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Affiliation(s)
- Mona Elshafie
- Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | | | - Raji Ganesan
- Birmingham Women’s NHS Foundation Trust, Birmingham, UK
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