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Chen JW, Huang YJ, Wang LL, Liu JJ, Shi MM, Li N. Mullerian adenosarcoma of the uterus with MASO: a case report of cervical adenosarcoma in a young female that never had sexual behavior. BMC Womens Health 2024; 24:308. [PMID: 38783282 PMCID: PMC11112954 DOI: 10.1186/s12905-024-03140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Cervical mullerian adenosarcoma is a rare uterine sarcoma, especially in young women. Its pathological features are low-grade malignant tumors with bidirectional differentiation, and the degree of malignancy is similar to that of low-grade endometrial stromal sarcoma. This paper reports the case of a young asexual patient who has been closely followed up after tumor resection and has not had any recurrences. CASE PRESENTATION A 20-year-old, young asexual woman was diagnosed with cervical mullerian adenosarcoma with sarcomatous overgrowth (MASO). Cervical tumor resection was performed after admission, and the resection margin was negative. After the operation, she refused to undergo secondary surgery due to fertility requirements and did not receive adjuvant treatment. The patient was closely followed up after the operation and has not yet relapsed. CONCLUSION A young woman with cervical MASO did not receive adjuvant treatment after cervical tumor resection. For women with fertility requirements, close follow-ups should be conducted after the operation to guard against tumor recurrence and radical tumor resection should be performed as early as possible after the patient no longer requires their fertility.
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Affiliation(s)
- Jia-Wei Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Ya-Jie Huang
- Department of Obstetrics and Gynecology, The Sixth People's Hospital of Chengdu, Chengdu, Sichuan, 610051, China
| | - Ling-Lu Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Jun-Jiang Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Ming-Mei Shi
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Na Li
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China.
- Department of Obstetrics and Gynecology, The Sixth People's Hospital of Chengdu, Chengdu, Sichuan, 610051, China.
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Karabajakian A, Genestie C, Meeus P, Guyon F, Llacer Moscardo C, Croce S, Taieb S, Duffaud F, Pautier P, Ray-Coquard I, Blay JY. [Uterin adenosarcoma: French Guidelines of the French Sarcoma Group and the Rare Gynecologic Tumor Group]. Bull Cancer 2023; 110:836-843. [PMID: 37202293 DOI: 10.1016/j.bulcan.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Uterine adenosarcoma is a very rare malignancy defined as a biphasic tumor composed of both benign epithelial component and a malignant sarcoma component. The stage of the disease is determined by the presence of myometrial invasion and the extent of extra-uterine disease. The most important histopronostic factors are the existence of a sarcomatous overgrowth defined by a sarcomatous contingent occupying more than 25 % of the volume of the tumor (directly correlated to the grade of the disease), the presence of a heterologous and/or a high-grade component. Stage I adenosarcomas without sarcomatous overgrowth have a good prognosis, with an overall 5-year survival of up to 80 %. In localized disease, complete surgical removal is recommended. The role of hormone therapy, chemotherapy and adjuvant radiotherapy is not established. If possible, relapses should be re-treated surgically, with the aim of achieving complete resection. In the advanced inoperable or metastatic setting, hormone therapy is an option for low-grade adenosarcomas with estrogen receptor (ER) and progesterone receptor (PR) overexpression. For high-grade tumors, the standard chemotherapies are doxorubicin-based combinations, although an integrated approach of surgery and medical treatment should also be considered in this setting.
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Affiliation(s)
- Andy Karabajakian
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Catherine Genestie
- Gustave-Roussy cancer campus, service de biopathologie, 94805 Villejuif, France
| | - Pierre Meeus
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Centre Léon-Bérard, département de chirurgie oncologique, 69008 Lyon, France
| | - Frédéric Guyon
- Institut Bergonié, département de chirurgie oncologique, 33076 Bordeaux, France
| | - Carmen Llacer Moscardo
- Institut du cancer de Montpellier (ICM), département de radiothérapie oncologique, 208, avenue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 5, France
| | - Sabrina Croce
- Institut Bergonié, département de biopathologie, 33076 Bordeaux, France
| | - Sophie Taieb
- Centre Oscar Lambret, département de radiologie, 59000 Lille, France
| | - Florence Duffaud
- AP-HM, hôpitaux universitaires de Marseille Timone, département d'oncologie médicale, 13005 Marseille, France
| | - Patricia Pautier
- Gustave-Roussy Cancer Campus, département d'oncologie médicale, 94805 Villejuif, France.
| | - Isabelle Ray-Coquard
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Jean-Yves Blay
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
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Dowding DD, Wayne LM, Guirguis AS. High grade uterine adenosarcoma with sarcomatous overgrowth in a young woman amenable to primary surgical reduction: A case study and literature review. Gynecol Oncol Rep 2022; 39:100920. [PMID: 35036509 PMCID: PMC8749193 DOI: 10.1016/j.gore.2021.100920] [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: 10/02/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 11/17/2022] Open
Abstract
Mullerian adenosarcomas are rare and often low-grade mixed tumors that typically respond well to optimal surgical resection. However, adenosarcoma with sarcomatous overgrowth (ASSO) is a high-grade mixed tumor commonly associated with invasion, metastasis, and a poor prognosis. The health care providers herein report a case study of a patient diagnosed with ASSO who has maintained remission status for 19 months following radical surgical resection alone. The patient, a 24-year-old Caucasian female without significant medical history, initially complained of abdominal fullness, pelvic pressure, altered menses, and unintentional weight loss. A necrotic cervical mass was present on the exam; mass biopsy revealed spindle cell sarcoma with rhabdomyosarcomatous differentiation. The patient underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingectomy, radical tumor debulking, and pelvic and periaortic lymph node dissection. Histopathological diagnosis of the resected specimen was consistent with ASSO, limited to 0.7 cm out of 2.0 cm of myometrial thickness, with negative lymph node and parametrial tissue, consistent with Stage IB disease. She did not receive adjuvant chemotherapy or radiation and has remained disease-free to date. Because of the rarity of ASSO and lack of abundant case study reports, uniform clinical guidelines for treatment following surgical resection of a high-grade adenosarcoma remain unclear. However, the case study below may suggest that radical surgical debulking of this disease with negative margins in young patients with early-stage disease can be sufficient in treating high-grade ASSO, despite their typical aggressive nature.
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Affiliation(s)
- D D Dowding
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO 63501, United States
| | - L M Wayne
- Gynecologic Cancer Institute of Chicago, Oak Lawn, IL 60453, United States
| | - A S Guirguis
- Gynecologic Cancer Institute of Chicago, Oak Lawn, IL 60453, United States
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García-Mendoza YI, Murguia-Perez M, Galván-Linares AI, Mendoza-Ramírez S, García-Salinas NL, Moctezuma-Ramírez JG, Murillo-Ortiz BO, Bueno-Rosario LJ, Olvera-Olvera MA, Corredor-Alonso GE. Case Report: Uterine Adenosarcoma With Sarcomatous Overgrowth and Malignant Heterologous Elements. Front Med (Lausanne) 2022; 8:819141. [PMID: 35083260 PMCID: PMC8784412 DOI: 10.3389/fmed.2021.819141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022] Open
Abstract
A 46- year-old woman presented a uterine adenosarcoma originating in the lower uterine segment. The diagnosis was made in an endometrial biopsy and confirmed in the pathological examination of the complete surgical specimen, both identifying heterologous malignant elements. In addition, complementary immunohistochemical studies were performed. We reviewed the literature, illustrating the clinical and morphological characteristics and the differential diagnoses to be evaluated.
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Affiliation(s)
- Yunuén I. García-Mendoza
- Department of Surgical Pathology, Speciality Hospital N°1 National Medical Center Bajio, Social Security Mexican Institute, University of Guanajuato, Leon, Mexico
| | - Mario Murguia-Perez
- Head of Department of Surgical Pathology, Speciality Hospital N°1 National Medical Center Bajio, Social Security Mexican Institute, University of Guanajuato, León, Mexico
| | - Aldo I. Galván-Linares
- Department of Surgical Pathology, Speciality Hospital N°1 National Medical Center Bajio, Social Security Mexican Institute, University of Guanajuato, Leon, Mexico
| | - Saulo Mendoza-Ramírez
- Pathology Unit, General Hospital of Mexico “Dr. Eduardo Liceaga”, National Autonomous University of Mexico, México, Mexico
| | - Norma L. García-Salinas
- Department of Surgical Pathology, Speciality Hospital N°1 National Medical Center Bajio, Social Security Mexican Institute, University of Guanajuato, Leon, Mexico
| | - Julio G. Moctezuma-Ramírez
- Department of Surgical Pathology, Speciality Hospital N°1 National Medical Center Bajio, Social Security Mexican Institute, University of Guanajuato, Leon, Mexico
| | - Blanca O. Murillo-Ortiz
- Research Unit of Clinic Epidemiology, Speciality Hospital N°1 National Medical Center Bajio, Social Security Mexican Institute, Leon, Mexico
| | - Luis Jonathan Bueno-Rosario
- Head of Oncology Unit, Speciality Hospital N°1 National Medical Center Bajio, Social Security Mexican Institute, Leon, Mexico
| | - Marco A. Olvera-Olvera
- Department of Radiology, Speciality Hospital N° 1 National Medical Center Bajio, Social Security Mexican Institute, University of Guanajuato, Leon, Mexico
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Rizzo A, Pantaleo MA, Saponara M, Nannini M. Current status of the adjuvant therapy in uterine sarcoma: A literature review. World J Clin Cases 2019; 7:1753-1763. [PMID: 31417921 PMCID: PMC6692269 DOI: 10.12998/wjcc.v7.i14.1753] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/16/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
Uterine sarcomas (US) are rare mesenchymal tumours accounting approximately for 3%–7% of all uterine cancers. Histologically, US are classified into mesenchymal tumours or mixed epithelial and mesenchymal tumours. The group of mesenchymal tumours includes uterine leiomyosarcoma (uLMS, 65% of cases), endometrial stromal sarcoma (ESS, 21%) – traditionally divided into low grade (LG-ESS) and high grade–undifferentiated uterine sarcoma (5%) and other rare subtypes such as alveolar or embryonal rhabdomyosarcoma. Despite the fact that several drugs demonstrated clinical activity in advanced or metastatic settings, the role of postoperative therapy in US remains controversial. In this review, we have summarised the current state of the art, including the chief trials on adjuvant treatment modalities in US, especially focusing on uLMS, LG-ESS and other rare histotypes.
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Affiliation(s)
- Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
| | - Maria Abbondanza Pantaleo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
| | - Maristella Saponara
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
| | - Margherita Nannini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
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