1
|
Jadhav T, Madakshira MG, Garud S. Embryonal rhabdomyosarcoma of the uterine cervix in an adult female. Autops Case Rep 2023; 13:e2023419. [PMID: 36777814 PMCID: PMC9910305 DOI: 10.4322/acr.2023.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023]
Abstract
Embryonal rhabdomyosarcoma (RMS) of the female genital tract is an uncommon malignancy, presenting mainly in the pediatric and adolescent populations, primarily affecting the first two decades of life. This malignancy presentation in adulthood is rare and is seldom seen. The incidence of this tumor affecting adult females is approximately 0.4 - 1%, with the common site being the vagina. This tumor infrequently involves the cervix. RMS has a poor survival rate and once diagnosed, it requires aggressive management by radical surgery accompanied by chemoradiation. We present a case of an anaplastic variant of embryonal RMS of the uterine cervix presenting as a cervical polyp in a 36-year-old female who complained of dyspareunia and post-coital bleeding.
Collapse
Affiliation(s)
- Toyaja Jadhav
- 12 Airforce HospitalDepartment of Laboratory SciencesGorakhpurUttar PradeshIndia12 Airforce Hospital, Department of Laboratory Sciences, Gorakhpur, Uttar Pradesh, India
| | - Manoj Gopal Madakshira
- Command HospitalDepartment of Pathology LucknowUttar PradeshIndiaCommand Hospital, Department of Pathology Lucknow, Uttar Pradesh, India
| | - Sushil Garud
- 12 Airforce HospitalDepartment of Obstetrics and GynecologyGorakhpurUttar PradeshIndia12 Airforce Hospital, Department of Obstetrics and Gynecology, Gorakhpur, Uttar Pradesh, India
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Ng ZY, Yeo YC, Lim TYK, Aggarwal IM. Two Cases of Extrauterine Müllerian Adenosarcoma Arising from Pelvic Endometriosis. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zheng Yuan Ng
- Department of Gynaecological Oncology, and KK Women's and Children's Hospital, Singapore, Singapore
| | - Yen Ching Yeo
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Timothy Yong Kuei Lim
- Department of Gynaecological Oncology, and KK Women's and Children's Hospital, Singapore, Singapore
| | - Ieera Madan Aggarwal
- Department of Gynaecological Oncology, and KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
4
|
Uterine Sarcomas: Surgical Management, Adjuvant Therapy and Survival Outcome. Experience at Gujarat Cancer and Research Institute. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-018-0247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Abstract
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.
Collapse
Affiliation(s)
- Michael J Nathenson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Nicole Fleming
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Anthony Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| |
Collapse
|
6
|
Özgü E, Narin MA, Yalçın HR, Taşçı T, Güngör T, Çavuşoğlu D, Meydanlı MM, Tulunay G. Uterine adenosarcomas: A dual-institution experience. J OBSTET GYNAECOL 2016; 37:93-96. [PMID: 27923317 DOI: 10.1080/01443615.2016.1228619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There has been limited literature about treatment and follow-up strategies of uterine adenosarcomas because of their rare nature. For this study we retrospectively investigated the medical database of the two major womens' health hospitals in Turkey. A total of 15 patients were identified from the hospital's database. Median follow-up was 86.43 months for all patients. Seven out of 15 patients had recurrences during their follow-up. Among these 7 patients, 4 of them had stage IA disease. Median Disease Free Survival (DFS) and Overall Survival (OS) were calculated as 41.47 and 57.21 months, respectively. According to our study, polypoid tumours confined to the uterus with superficial myometrial invasion can be treated without comprehensive surgical staging. We believe that, publishing all the data in an organised manner even though they are small in size, gives us an opportunity to design meta-analysis for the development of more appropriate treatment strategies.
Collapse
Affiliation(s)
- Emre Özgü
- a Department of Gynaecologic Oncology , Zekai Tahir Burak Women Health Education and Research Hospital , Ankara , Turkey
| | - Mehmet Ali Narin
- b Department of Gynaecologic Oncology , Etlik Zübeyde Hanım Women Health Education and Research Hospital , Ankara , Turkey
| | - Hakan Raşit Yalçın
- a Department of Gynaecologic Oncology , Zekai Tahir Burak Women Health Education and Research Hospital , Ankara , Turkey
| | - Tolga Taşçı
- b Department of Gynaecologic Oncology , Etlik Zübeyde Hanım Women Health Education and Research Hospital , Ankara , Turkey
| | - Tayfun Güngör
- a Department of Gynaecologic Oncology , Zekai Tahir Burak Women Health Education and Research Hospital , Ankara , Turkey.,c Depertment of Obstetrics and Gynaecology , Hitit University Faculty of Medcine , Çorum , Turkey
| | - Deniz Çavuşoğlu
- d Department of Pathology , Etlik Zübeyde Hanım Women Health Education and Research Hospital , Ankara , Turkey
| | - Mehmet Mutlu Meydanlı
- a Department of Gynaecologic Oncology , Zekai Tahir Burak Women Health Education and Research Hospital , Ankara , Turkey
| | - Gökhan Tulunay
- b Department of Gynaecologic Oncology , Etlik Zübeyde Hanım Women Health Education and Research Hospital , Ankara , Turkey
| |
Collapse
|
7
|
Uterine polyps with features overlapping with those of Müllerian adenosarcoma: a clinicopathologic analysis of 29 cases emphasizing their likely benign nature. Am J Surg Pathol 2015; 39:116-26. [PMID: 25118811 DOI: 10.1097/pas.0000000000000303] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Müllerian adenosarcoma (MA) is a mixed Müllerian neoplasm composed of malignant stroma and benign epithelium. Endometrial and endocervical polyps are common entities in surgical pathology practice and most can be readily distinguished from MA; however, some have overlapping features, causing diagnostic confusion. In this study, we examined uterine polyps falling short of the diagnosis of MA quantitatively, qualitatively, or both. Our aims were to (1) characterize formally the morphologic features of atypical uterine polyps and (2) determine clinical outcome. Cases were evaluated for morphologic features of MA (phyllodes-like architecture, intraglandular polypoid projections, altered periglandular stroma, and stromal cytologic atypia), and the maximum number of mitoses per 10 high-power fields. The percentage involvement within a polyp by any atypical feature was estimated. The most common change was abnormal architecture, although periglandular stromal abnormalities and increased mitoses were also frequent findings. Stromal cytologic atypia was rare and when present was focal and mild. Histologic follow-up was performed in 24/29 (86%). Two patients had uterine polyps with unusual features similar to those noted on the initial biopsy. The remainder showed either polyp without unusual features or no residual polyp. Clinical follow-up information was available for 28/29 (97%). Twenty-seven of 28 were alive without evidence of disease, whereas 1 patient had died of pancreatic adenocarcinoma. We have shown that uterine polyps with features overlapping with those of MA have a benign clinical course, even with conservative management, as no cases showed progression or malignant transformation.
Collapse
|
8
|
Bernard B, Clarke BA, Malowany JI, McAlpine J, Lee CH, Atenafu EG, Ferguson S, Mackay H. Uterine adenosarcomas: a dual-institution update on staging, prognosis and survival. Gynecol Oncol 2013; 131:634-9. [PMID: 24135678 DOI: 10.1016/j.ygyno.2013.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/06/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Uterine adenosarcomas (AS) are rare tumors thought to have a favorable prognosis. The aim of this study was to evaluate clinicopathological characteristics and treatment outcome in women with uterine AS. METHODS Patients with uterine AS were identified from the institutional databases at two regional cancer centers, Princess Margaret Hospital, Toronto and Vancouver General Hospital. All cases underwent specialist pathological review and were re-staged according to FIGO criteria (2009). Patient demographics, treatment data and outcomes were evaluated. RESULTS Between 1984 and 2010, 64 patients with confirmed AS were identified: 30 exhibited sarcomatous overgrowth (AS+SO). 47 patients presented with stage I disease: 27 IA and 18 IB. 57 of the 58 patients with known surgical management underwent hysterectomy: 55 having bilateral salpingo-oophorectomy, 12 having lymph node dissection. 14 patients received adjuvant treatment: 10 radiotherapy, 3 chemotherapy and 1 both. Sixteen of the 45 patients (35.6%) with follow-up recurred; median time to recurrence 21.2 months, range 2.1-87.8 months. Recurrence was associated with myometrial invasion (p=0.05). Two of the 10 women (20%) with AS+SO receiving adjuvant treatment recurred compared to 9 of the 14 (64%) who did not. One of the 5 women (20%) with stage IB disease who received adjuvant treatment recurred (20%) compared to 6 of the 7 (85.6%) who did not. CONCLUSIONS Long term surveillance is required given the variable time to recurrence. For those with AS+SO and myometrial invasion adjuvant treatment should be considered and further investigation of adjuvant strategies is warranted.
Collapse
Affiliation(s)
- Brandon Bernard
- Department of Medical Oncology, Princess Margaret Hospital, University of Toronto, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Synchronous occurrence of primary malignant mixed müllerian tumor in ovary and uterus. Obstet Gynecol Sci 2013; 56:269-72. [PMID: 24328014 PMCID: PMC3784138 DOI: 10.5468/ogs.2013.56.4.269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/08/2013] [Accepted: 02/13/2013] [Indexed: 11/30/2022] Open
Abstract
Malignant mixed müllerian tumor (MMMT) arising from female internal genitalia is rare with the uterine corpus being the most prevalently affected site. It is even more rare when it occurs on both uterus and ovary at the same time. We describe a case of synchronized occurrence of MMMT on ovary and uterine adenosarcoma with review of literature.
Collapse
|
10
|
Ulker V, Yavuz E, Gedikbasi A, Numanoglu C, Sudolmus S, Gulkilik A. Uterine adenosarcoma with ovarian sex cord-like differentiation: a case report and review of the literature. Taiwan J Obstet Gynecol 2012; 50:518-21. [PMID: 22212329 DOI: 10.1016/j.tjog.2011.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2010] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To determine the prognosis of uterine adenosarcoma with ovarian sex cord like-differentiation after treatment and to review the literature. CASE REPORT A 47-year-old premenopausal unmarried woman presented with irregular menstrual bleeding and uterine mass. Sonographic examination, suggested two uterine fibroids located in the uterine fundus and cervix measuring 4 × 3 cm and 3 × 3 cm, respectively. Total abdominal hysterectomy with bilateral salpingo-oopherectomy was performed and the histopathology report confirmed the diagnosis of uterine adenosarcoma with ovarian sex cord like-differentiation. The patient received neither chemotherapy nor other adjuvant therapy because the tumor had low malignant potential, and the extent of myometrial invasion was less than half of the whole myometrium. The patient had an uneventful recovery, and no recurrence was detected for 2 years in the follow-up period. CONCLUSION Uterine adenosarcomas mostly have relatively low malignant potential. Surgery is the optimal standard treatment for patients. Although there is not enough data in the present literature, benign epithelial differentiations, such as sex cord-like elements may reflect the behaviour of the tumour and shows the tendency to have a benign course in most of cases.
Collapse
Affiliation(s)
- Volkan Ulker
- Department of Obstetrics and Gynecology, Bakirkoy Women and Children Training and Research Hospital, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
11
|
Mullerian adenosarcoma of uterus with sarcomatous overgrowth and heterologous component associated with stromal deposit in omentum: a case report and review of the literature. Case Rep Med 2012; 2012:820378. [PMID: 22952480 PMCID: PMC3431108 DOI: 10.1155/2012/820378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/15/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very rare variant of uterine sarcomas first described by Clement et al. as early as 1974. The presence of heterologous sarcomatous components is associated with aggressive biological behavior. Case Presentation. This is a case report of a 62-year female (P(2 + 0)) presenting with postmenopausal vaginal bleeding. Her preoperative USG revealed subserosal fibroid with adherent omentum. She underwent abdominal hysterectomy with bilateral oophorectomy. Histopathological diagnosis of resected specimen was Mullerian adenosarcoma with sarcomatous overgrowth and presence of heterologous elements involving body of the uterus. The whole thickness of the myometrium was involved along with the presence of serosal nodules and omental deposits of sarcomatous component. Conclusion. MA is considered as a low-grade malignant tumor, but MASO is a high-grade tumor frequently associated with invasion and metastasis with poor treatment outcome. Because of its rarity, correct identification of these tumors and distinction from other uterine sarcomas are a challenging job and hence its morphological features merits attention.
Collapse
|
12
|
Gruber TJ, Fabiano AJ, Deeb G, Lele SB, Fenstermaker RA. Intracranial meningiomas in patients with uterine sarcoma treated with long-term megestrol acetate therapy. World Neurosurg 2012; 76:477.e16-20. [PMID: 22152580 DOI: 10.1016/j.wneu.2011.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 03/03/2011] [Accepted: 03/25/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a series of four patients with uterine sarcoma, including one with müllerian adenosarcoma (MA) and three with low-grade endometrial stromal sarcoma (LGESS), who developed intracranial meningiomas while receiving the progesterone agonist megestrol acetate. METHODS The hospital records, imaging studies, and pathology slides of four patients who were treated for uterine sarcomas and subsequently developed intracranial meningiomas were reviewed. RESULTS All patients underwent surgery for their gynecologic cancers and received maintenance therapy with long-term hormonal suppression with megestrol acetate. Each of the four patients later developed neurologic symptoms secondary to intracranial meningiomas. Three patients had more than one meningioma. Histopathologic examination of all excised tumors showed strong immunoreactivity for progesterone receptors (PRs). CONCLUSIONS Patients with uterine sarcoma subtypes LGESS and MA may be predisposed to develop meningiomas, particularly in the setting of long-term treatment with megestrol acetate. Alternatively, preexisting, clinically silent meningiomas in these patients may have progressed to the point of clinical symptoms in the presence of the progesterone agonist megestrol acetate. Without previous imaging studies showing the presence or absence of meningioma before initiation of megestrol acetate treatment, there is no way to draw definitive conclusions regarding this possibility. Clinical and neuroradiologic surveillance for meningiomas should be strongly considered in patients with these uterine sarcoma subtypes, particularly in patients undergoing long-term suppressive therapy with megestrol acetate.
Collapse
Affiliation(s)
- Thomas J Gruber
- Department of Neurosurgery, Roswell Park Cancer Institute and School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
| | | | | | | | | |
Collapse
|
13
|
Tse KY, Crawford R, Ngan HYS. Staging of uterine sarcomas. Best Pract Res Clin Obstet Gynaecol 2011; 25:733-49. [PMID: 21752716 DOI: 10.1016/j.bpobgyn.2011.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/28/2011] [Indexed: 10/17/2022]
Abstract
Uterine sarcomas comprise leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, undifferentiated endometrial sarcoma, and their variants. Carcinosarcoma is historically classified as sarcoma, but it is now regarded as a metaplastic carcinoma. Uterine sarcomas are rare, and are traditionally staged in the same way as endometrial carcinoma. Because of their different clinical and biological behaviours, the International Federation of Gynecology and Obstetrics introduced a new staging system in 2009 for leiomyosarcoma, endometrial stromal sarcoma and adenosarcoma, and carcinosarcoma, respectively. Following an extensive literature review no good evidence was found to support the modification of the staging system. This is mainly because of the rarity of the sarcomas and the heterogeneity of the reports, the different diagnostic criteria and treatments changing over the decades the retrospective nature and small sample size in most studies, and the lack of uniform pathological review even in large studies. Currently, evidence is still lacking about the use of preoperative imaging for staging purpose, and uterine sarcomas remain to be surgically staged. Total hysterectomy is the cornerstone for both staging and treatment. Newer evidence shows that routine lymphadenectomy and bilateral salpingo-oophorectomy may not be necessary, unless in the presence of extra-uterine spread, suspicious ovaries or lymph nodes, and certain poor histological types, such as undifferentiated endometrial sarcoma and adenosarcoma with sarcomatous overgrowth. More research and data collection are definitely needed in order to verify and further revise the current staging systems.
Collapse
Affiliation(s)
- Ka Yu Tse
- 6/F, Professorial Block, Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong.
| | | | | |
Collapse
|
14
|
Patrelli TS, Silini EM, Gizzo S, Berretta R, Franchi L, Thai E, Lukanovic A, Nardelli GB, Modena AB. Extragenital Müllerian adenosarcoma with pouch of Douglas location. BMC Cancer 2011; 11:171. [PMID: 21575150 PMCID: PMC3115912 DOI: 10.1186/1471-2407-11-171] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 05/15/2011] [Indexed: 11/23/2022] Open
Abstract
Background Of all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Müllerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature. Case Presentation A 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Müllerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy. Conclusions The case of Müllerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst.
Collapse
Affiliation(s)
- Tito S Patrelli
- Department of Obstetrics, Gynecological and Perinatology Sciences, University of Parma, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Arend R, Bagaria M, Lewin SN, Sun X, Deutsch I, Burke WM, Herzog TJ, Wright JD. Long-term outcome and natural history of uterine adenosarcomas. Gynecol Oncol 2010; 119:305-8. [PMID: 20688363 DOI: 10.1016/j.ygyno.2010.07.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/01/2010] [Accepted: 07/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Adenosarcomas are rare tumors composed of a benign epithelium in combination with a malignant mesenchymal component. We examined the natural history of uterine adenosarcomas and compared the outcome of uterine adenosarcoma and carcinosarcoma. METHODS Patients with uterine adenosarcomas and carcinosarcomas registered in the Surveillance, Epidemiology, and End Results database between 1988 and 2006 were examined. Survival was analyzed using Cox proportional hazards model and the Kaplan-Meier method. RESULTS A total of 5496 patients including 544 (10%) with adenosarcomas were identified. Patients with adenosarcomas tended to be younger and were more likely to have early-stage tumors (p<0.0001) In a multivariate model patients with adenosarcomas were 65% (HR=0.35; 95% CI, 0.28-0.45) less likely to die from their tumors than women with carcinosarcomas. Five-year survival was 79% (95% CI, 75-84%) for stage I adenosarcomas and 51% (95% CI, 49-54%) for carcinosarcomas. For stage III disease, 5-year survival for adenosarcomas was 48% (95% CI, 29-65%) vs. 24% (95% CI, 20-27%) for carcinosarcomas. CONCLUSION The majority of women with uterine adenosarcoma present with early-stage tumors and have a favorable outcome. Despite the overall favorable prognosis for most patients, survival is only 63-69% for women whose tumors invade into the wall of the uterus and lower than 50% for disease spread beyond the uterus.
Collapse
Affiliation(s)
- Rebecca Arend
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgenos, New York, NY 10032, USA
| | | | | | | | | | | | | | | |
Collapse
|