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Bendimya M, Al Jarroudi O, Brahmi SA, Afqir S. A Case Report of Uterine Müllerian Adenosarcoma With Sarcomatous Overgrowth. Cureus 2024; 16:e51806. [PMID: 38322085 PMCID: PMC10846754 DOI: 10.7759/cureus.51806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/08/2024] Open
Abstract
Uterine adenosarcoma remains a highly aggressive tumor and is less described in the literature, with an unfavorable prognosis and an increased risk of local and distant recurrence. However, surgery, chemotherapy, and radiotherapy offer local control of the disease, and overall survival remains reduced. We report the case of a 79-year-old patient with stage IIIB uterine adenosarcoma, confirmed by immunohistochemistry and initially diagnosed with postmenopausal metrorrhagia. The patient was managed through a multimodal treatment by conducting a multidisciplinary consultation.
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Affiliation(s)
- Mohammed Bendimya
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital Center, Oujda, MAR
| | | | - Sami Aziz Brahmi
- Medical Oncology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Said Afqir
- Medical Oncology, Mohammed VI University Hospital Center, Oujda, MAR
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Rana IA, Hassan U, Bashir S, Hussain M, Shakeel M, Mushtaq S. Müllerian Adenosarcoma: A Single-Centre Experience of 59 Cases of This Rare Entity. Cureus 2021; 13:e13360. [PMID: 33747657 PMCID: PMC7969483 DOI: 10.7759/cureus.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and objective Müllerian adenosarcomas (MA) are rare biphasic tumors with benign epithelial and sarcomatous stromal components. There is very limited cohort study data on MA in the South Asian countries and no such study has been attempted in Pakistan. Our aim was to evaluate the clinicopathological characteristics of MA and to review the published literature on the condition. Additionally, we also analyzed the impact of various prognostic factors on the overall survival (OS) of patients with MA. Materials and methods This was a retrospective observational study performed at the Shaukat Khanum Memorial Hospital and Research Centre, Lahore from 2003 to 2020. A total of 59 histologically confirmed cases of MA were included in the study and critically reviewed. Results The mean age of the patients was 54 ±16 years, and the most common tumor location was the uterine corpus (48, 81.4%), followed by the cervix (eight, 13.6%), ovary (two, 3.4%), and vagina (one, 1.7%). Sarcomatous overgrowth (SO) was seen in 22 (37.3%) patients, and high-grade cytology was observed in 18 (30.5%) patients. Furthermore, lymphovascular invasion (LVI) was present in six (10.2%) patients, and myometrial invasion was noted in 25 (42.4%) patients. The follow-up details of 29 patients were available, and death was recorded in 13 (44.8%) patients with a median OS of three years. Conclusion MA is a rare and diagnostically challenging entity due to its wide differential diagnosis. It is essential to take note of different morphological features such as SO, cytological features, LVI, and heterologous differentiation because of their significant prognostic impact.
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Affiliation(s)
- Iftikhar Ali Rana
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Usman Hassan
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Shaarif Bashir
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mudassar Hussain
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mehroosh Shakeel
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Mushtaq
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Abstract
RATIONALE Uterine adenosarcoma (UA) with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. Herein, wereported the case of a young patient with advanced uterine ASSO. PATIENTS CONCERNS A 29-year-old woman with the diagnoses of endometrial polyp and adenomyosis underwent hysteroscopic endometrial polypectomy for the giant endometrial polyp. Postoperative regular ultrasound scan indicated thickened endometriumand an ill-defined mass with continuous enlargement in the myometrium of the posterior wall of the uterus, which was considered as an adenomyoma. Two years after hysteroscopy, she was re-admitted due to lower abdominal distension and large pelvic mass. At that time, she had taken oral short-acting contraceptives for 2.5 years. DIAGNOSES Magnetic resonance imaging (MRI) of the pelvis revealed an irregular mass with the size of 12*56*107 mm in the right annex area, without distinct border with the rectum, moreover, an uneven intrauterine echo that has no obvious boundary with uterine wall. Right ovarian cancer and adenomyoma were initially considered. INTERVENTIONS The patient received transperitoneal retroperitoneal pelvic combined with total viscera resection, including uterus, bilateral appendages and rectum, omentectomy, appendectomy, lymphadenectomy, and ileostomy. Postoperative pathology confirmed ASSO in the uterine cavity and muscular layer, the whole cervical duct and the right adnexal. She underwent 2 systemic chemotherapy sessions after the surgery. The chemotherapy regimen was ifosfamide 2.5 g day 1 to 3, with liposomal doxorubicin 40 mg day 1. OUTCOMES The final diagnosis was uterine ASSO, International Federation of Gynecology and Obstetrics stage IVa. The patient has been following-up so far, with no progression. LESSONS Review of the case indicated that history of long-term oral short-acting contraceptives and giant endometrial polyps may be the high-risk factors for UA. For patients with high-risk factors, the follow-up ultrasound scan should be more frequently conducted. Moreover, 3D-ultrasound, MRI and outpatient hysteroscopy are recommended for routine screening. Placement of levonorgestrel-releasing intra-uterine system after hysteroscopy may be an effective intervention for patients with a high risk of giant polyps. Cluster of Differentiation 10, Estrogen receptor, Progesterone receptor, and nuclear antigen may be predictors for prognosis and selection of individualized treatment program.
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Mohapatra D, Mohanty P, Biswal R. Mullerian adenosarcoma (heterologous) of uterine cervix with sarcomatous overgrowth: A case report with review of the literature. INDIAN J PATHOL MICR 2019; 62:139-141. [PMID: 30706880 DOI: 10.4103/ijpm.ijpm_77_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mullerian adenosarcoma is a rare biphasic malignant neoplasm of cervix characterized by an admixture of benign epithelial elements and a malignant sarcomatous stromal component, which may be either homologous or heterologous. Mullerian adenosarcoma with stromal overgrowth (MASO) in an aggressive variant of adenosarcoma, which is extremely rare with only two such cases reported till date. In this report, we present a case of MASO of cervix with heterologous elements in a 55/F presenting with postmenopausal bleeding. As it commonly simulates clinically and radiologically as benign cervical polyp, the gynecologists and pathologists should be aware of this extremely rare entity presenting with aggressive clinical course.
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Affiliation(s)
- Debahuti Mohapatra
- Department of Pathology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Pranita Mohanty
- Department of Pathology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Rupanita Biswal
- Department of Pathology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India
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Abstract
INTRODUCTION Uterine adenosarcoma is a rare tumor with both epithelial and stromal components. Standard treatment is total abdominal hysterectomy and bilateral salpingo-oophorectomy. There is no defined role for adjuvant or neoadjuvant chemotherapy or radiation. There is a misconception that this is an indolent, low-grade sarcoma. In fact, at least 50% of patients will develop disease recurrence. Establishing prognostic factors is of paramount importance. Areas covered: This article reviews the current literature regarding adenosarcoma prognostic factors from case reports, case series, and retrospective series. An extensive review of the literature was undertaken via PubMed and Medline searches, relevant articles are included in this review. Expert commentary: The most important prognostic factors of uterine adenosarcoma are age, presence of sarcomatous overgrowth, presence of myometrial invasion, presence of lymphovascular invasion, and lymph node involvement. These factors can be used to accurately prognosticate for uterine adenosarcoma patients. Patients at low risk of disease recurrence can be identified. These patients require observation alone. Patients at high risk of disease recurrence can be identified and are candidates for aggressive therapy with adjuvant chemotherapy to reduce the risk of disease recurrence.
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Affiliation(s)
- Michael J Nathenson
- a Center for bone and soft tissue sarcomas , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Anthony P Conley
- b Department of Sarcoma Medical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Nannini M, Dondi G, Santini D, De Leo A, Dei Tos AP, Zamagni C, Saponara M, Gatto L, Nigro C, Bertaccini P, Zompatori M, De Iaco P, Perrone AM, Perrone MA, Pantaleo MA. A Single-Centre Experience on the Management of Adenosarcoma: A Successful Report of an Integrated Medical and Surgical Approach. Clin Med Insights Oncol 2018; 12:1179554918782477. [PMID: 29977120 PMCID: PMC6024524 DOI: 10.1177/1179554918782477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/22/2018] [Indexed: 12/13/2022]
Abstract
Adenosarcomas are the rarest form of uterine sarcomas, and clinical experience with their management is still limited. Here, we reported 7 patients with uterine adenosarcoma referred to our institution, focusing on main pathologic features, their medical history, and long-term follow-up. Among these patients, we provided a detailed description of the medical history of a 49-year-old woman with advanced uterine adenosarcoma with sarcomatous overgrowth who presented a brilliant radiologic and pathologic response after 3 cycles of epirubicin and ifosfamide, ultimately achieving an extraordinary long-term outcome through an integrated surgical and medical approach. Our single-centre experience would suggest that aggressive uterine adenosarcomas with sarcomatous overgrowth are sensitive to standard epirubicin and ifosfamide and that an integrated approach, both medical and surgical, could be considered in clinical practice, again emphasizing the relevant role of multidisciplinary management for this extremely rare disease.
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Affiliation(s)
- Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Dondi
- Gynecologic Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Antonio De Leo
- Pathology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy.,Department of Medicine, School of Medicine, University of Padua, Padua, Italy
| | - Claudio Zamagni
- SSD Oncologia Medica "Addarii," S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lidia Gatto
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Concetta Nigro
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paola Bertaccini
- Radiology Unit, Cardio-Thoracic-Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maurizio Zompatori
- Radiology Unit, Cardio-Thoracic-Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | - Maria Abbondanza Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,"Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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