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Adenosarcoma of the uterus with Sarcomatous Overgrowth (SO) and Heterologous Elements (HE) is a rare and aggressive neoplasm that shares common clinical and radiological presentations. It is also referred to as Müllerian adenosarcoma, a slow-growing neoplasm characterised by a classical biphasic pattern comprising benign epithelial and malignant mesenchymal tissue. Adenosarcoma with a high-grade stromal component has an increased risk of recurrence. Hereby the authors present a case of 39-year-old female who was nulliparous, reported to the Department of Obstetrics and Gynaecology with abdominal pain, menorrhagia, and burning micturition. Her medical history included diabetes, hypertension, hypothyroidism, and morbid obesity. She had a past history of similar complaints, during which an endometrial biopsy had shown hyperplasia without atypia. She was lost for follow-up and returned after one and a half years, having developed endometrial hyperplasia with atypia. She returned only after six months with similar but more severe complaints. Clinically and radiologically, there was a polypoidal mass protruding through the cervical canal. The hysterectomy specimen revealed a tumour with histopathological features of Müllerian adenosarcoma with SO. Interestingly, both ovaries were enlarged, exhibiting marked stromal hyperplasia. A panel of immunohistochemical markers, including CD10, Ki67, S-100, desmin, Estrogen Receptor (ER), and Progesterone Receptor (PR), was used, and the findings were unusual for an adenosarcoma with high-grade stromal histology. The chronological progression from endometrial hyperplasia without atypia to hyperplasia with atypia in a nulliparous woman, along with bilateral ovarian stromal hyperplasia, represents a classical pattern of events. [ABSTRACT FROM AUTHOR]

Mullerian adenosarcoma is rare, usually found in the uterine corpus and rarely in the cervix. Adenosarcoma that grows diffusely in the uterine cavity and the cervical canal is even rarer without symptoms. Herein, we report a rare case of multiple primary malignant neoplasms of Mullerian adenosarcoma accidentally detected and coexisting with cervical carcinoma in situ. Fortunately, the tumor was in the early stage and the Mullerian adenosarcoma was treated together with the cervical carcinoma in situ by hysterectomy + bilateral adnexectomy. Histopathology and immunohistochemistry results confirmed this diagnosis, further confirmed by a pathology consultation at the University Hospital. The patient recovered well from the surgical treatment and was discharged with regular follow-up. The patient did not undergo pelvis--abdomen CT and diagnostic curettage preoperatively, and no malignancy was detected by cryopathology intraoperatively, which may be related to the rarity of the disease and the relative lack of awareness and experience of our clinicians and pathologists for this tumor. We hope that this rare case can provide some lessons for gynecologists and pathologists. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Uterine cervical Müllerian adenosarcoma (MA), a rare malignant tumor of the female reproductive organs, is composed of a benign epithelium and a lowgrade malignant stromal component. Because few studies have investigated the clinical management of MA, misdiagnosis often occur. Therefore, we proposed an optimal course of clinical management for patients with MA. MA is possibly a malignant transformation of the cystadenofibroma. In this study, we present a case of a 46-year-old woman who presented with symptoms of MA of the uterine cervix, such as metrorrhagia and a cyst in the cervical canals, after transvaginal excision of the left ovarian mucinous cystadenofibroma. [ABSTRACT FROM AUTHOR]

Mullerian adenosarcoma of the uterine cervix generally displays cervical polyps and can be often misdiagnosed as benign endocervical polyps both clinically and pathologically. A 52-year-old woman presented with a two-month history of postmenopausal bleeding. Pelvic examination revealed a large polyp-like mass protruding from the cervical ostium. Two preoperative consecutive biopsies showed a histologic diagnosis consistent with an endocervical polyp. Pelvic magnetic resonance imaging (MRI) depicted a lobulated well- enhancing endocervical mass, suggestive of an endocervical polyp based on the apparent diffusion coefficient (ADC) value. The patient was subjected to total hysterectomy with bilateral salpingectomy. Microscopically, the tumor was composed of epithelial and stromal components. The final pathologic diagnosis was Mullerian adenosarcoma of the cervix. The authors presented an unusual case that demonstrated an endocervical polyp on magnetic resonance imaging and two consecutive biopsies preoperatively. [ABSTRACT FROM AUTHOR]

Introduction: Uterine adenosarcoma mostly seen in elderly and there are limited data on appropriate approach in premenopausal patient and the accurate prognosis. Herein we aimed to present a young case of Müllerian adenosarcoma of uterus which had only 9 years old. Case report: A 9year old pre pubertal girl presented to the gynecology department of Isfahan University of Medical Sciences-Iran with the vaginal bleeding. An intrauterine mass was noted via hysteroscopic examination as the reason of abnormal bleeding. The final pathology revealed Müllerian adenosarcoma of uterus. Subsequently hysterectomy was done due to persistent perfused vaginal bleeding; with ovarian preservation. Conclusion: Due to rarity of Müllerian adenosarcoma, the gynecologists and pathologists should be reminded about the possibility of the diagnosis in young patients too. [ABSTRACT FROM AUTHOR]

Background: Adenosarcoma arises most commonly in the uterus. Rarely, it may arise from extrauterine sites, such as the pelvic peritoneum and rectovaginal septum. Two cases of extrauterine Müllerian adenosarcoma arising from pelvic endometriosis are discussed. Cases and Results:Case 1: A 63-year-old woman presented with vaginal bleeding and a rectovaginal nodule. She underwent an extended hysterectomy with resection of a rectovaginal mass. Histology revealed endometriotic tissue. She returned 21 months later with abdominal distension, and underwent resection of large pelvic abdominal masses. Histology showed an adenosarcoma with sarcomatous overgrowth. Her disease progressed despite chemotherapy, and she died 5 months later. Case 2: A 70-year-old woman with previous breast cancer presented with urinary retention. Computed tomography showed a 13-cm pelvic mass. She underwent total abdominal hysterectomy and salpingo-oophorectomy. Intraoperatively, dense pelvic endometriosis was seen. Histology showed a stage 1C borderline endometrioid adenofibromatous tumor. She also underwent resection of a 10-cm incidentally discovered pelvic mass 18 months later. Histology showed a low-grade adenosarcoma arising from pelvic endometriosis. She was started on letrozole, and remained well postoperatively. Conclusions: Compared to uterine adenosarcoma, an extrauterine location confers a higher mortality and recurrence risk. Higher stromal grade or sarcomatous overgrowth worsen the prognosis, whereas an association with endometriosis is protective. The mainstay of treatment is surgery. Some surgeons recommend fertility-sparing surgery when there is no sarcomatous overgrowth, while others advocate radical surgery with adjuvant chemotherapy or radiotherapy. Further research is needed to define screening, treatment, and follow-up better. Clinicians should consider this rare diagnosis in any woman presenting with a pelvic mass with a history of endometriosis. [ABSTRACT FROM AUTHOR]

Benign proliferations that mimic malignancies are commonly encountered during the course of assessment of small and fragmented endometrial samples. Although benign, endometrial epithelial metaplasias often coexist with premalignant or malignant lesions causing diagnostic confusion. The difficulty with mucinous metaplasia lies in its distinction from atypical mucinous glandular proliferations and mucinous carcinomas, which are associated with significant interobserver variability. Papillary proliferation of the endometrium is commonly associated with hormonal drugs and endometrial polyps and is characterised by papillae with fibrovascular cores covered by epithelial cells without cytologic atypia. They are classified into simple or complex papillary proliferations depending on the architectural complexity and extent of proliferation. Complex papillary proliferations are associated with a high risk of concurrent or subsequent hyperplasia with atypia/carcinoma. Papillary proliferations may have coexisting epithelial metaplasias and, most commonly, mucinous metaplasia and syncytial papillary change. Those with striking mucinous metaplasia overlap morphologically with papillary mucinous metaplasia. The latter has been proposed as a precursor of endometrial mucinous carcinoma. Misinterpreting the Arias-Stella reaction as a malignant or premalignant lesion is more likely to occur if the pathologist is unaware that the patient is pregnant or on hormonal drugs. Endometrial hyperplasia with secretory changes may occasionally be difficult to distinguish from the torturous and crowded glands of a late secretory endometrium. Endometrial polyps may have abnormal features that can be misinterpreted as endometrial hyperplasia or Mullerian adenosarcoma. Awareness of these benign endometrial proliferations and their common association with hormonal medication or altered endogenous hormonal levels will help prevent the over-diagnosis of premalignant and malignant lesions. [ABSTRACT FROM AUTHOR]

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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). [ABSTRACT FROM AUTHOR]

Non-puerperal uterine inversion due to uterine sarcomas represents a very rare event with no reliable estimate of frequency in the literature. Clinically, the diagnosis of inversion may be difficult, as far as imaging procedures are concerned, although ultrasonography may prove to be useful. However, some characteristics such as the indentation of the fundic area and a depressed longitudinal groove extending from the uterus to the center of the inverted portion are difficult to recognize. Moreover, there is no specific computed tomography feature accurate enough to aid in the differential diagnosis. Here, we report a case of uterine inversion due to Müllerian uterine adenosarcoma whose preoperative workup and diagnosis took advantage of the application of magnetic resonance imaging. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Rationale: There is little knowledge regarding mullerian adenosarcoma and its metastasizing pattern. Aim: Our objective was to evaluate the impact on the prognostic of the patient brought by tumor metastasizing to the retroperitoneum, to analyze the particularities of the treatment in such cases and to bring a significant change in the early therapeutic attitude to mullerian adenosarcomas. Methods and results: We present a first case report of a hypervascularized retroperitoneal metastasis from an initial low-grade uterine adenosarcoma. The presence of such a metastasis brought the worst prognostic factor to the patient. Conclusions: We consider that in front of a macroscopic polypoid mass there should be an active change in the diagnosis and in the therapeutic attitude. The frequent confusion between similar histopathological entities with different aggressiveness states and specific treatment responses, the poor outcome at advanced tumor stages, frequently in young patients, should trigger a universal remodeling in approaching these tumors. [ABSTRACT FROM AUTHOR]

Background: Uterine adenosarcoma, a rare uterine tumor subtype, is a biphasic tumor consisting of epithelial and mesenchymal elements. To date, there is no research comparing the histopathological features and immunohistochemistry of primary and recurrent tumors; furthermore, the relationship between pathology and the clinical course remains unclear. We reviewed the pathology and immunohistochemical features of patients with adenosarcoma and investigated the relevance of the histomorphological features to the clinical course. We also compared the immunohistochemical features of the primary and recurrent tumors. Methods: The data of seven patients with adenosarcoma who underwent surgery in our hospital were evaluated. We performed immunohistochemical staining for the progesterone receptor, estrogen receptor, p53, and two Switch/Sucrose Non-Fermentable chromatin remodeling proteins (SMARCA4, BCOR), which were recently developed for the undifferentiated sarcoma diagnosis in addition to conventional staining methods. Results: All patients had International Federation of Gynecology and Obstetrics stage IB–IC diseases. All tumors were polypoid and every patient presented with abnormal uterine bleeding. Six patients aged over 50 years and were menopausal; one patient aged under 50 years and was non-menopausal (average age: 59.1 years). Histologically, the sarcomatous components were homologous and heterogenous in six and one patient, respectively. Four and three cases were recurrent and non-recurrent, respectively. The recurrent patients showed high-grade morphology with sarcomatous overgrowth and were negative for ER and PR. Three recurrences could be evaluated by imaging, showing recurrence only in a distant area; biopsy specimens from these tissues revealed the identical mesenchymal component found in the primary tumor without a benign epithelial component. Immunohistochemical staining results were also similar to the corresponding of the original tumor, except for the p53 expression in one patient. At the primary site, p53 was overexpressed in two recurrent patients and had a wild-type level in one recurrent patient; however, all three recurrent tissues showed p53 overexpression. None of our patients showed SMARCA4 loss, and BCOR expression was positive in one case. Conclusions: Initial pathological adenosarcoma analysis with appropriate immunohistochemical staining is vital for prognostic assessment. p53 expression might increase at recurrence. SMARCA4 and BCOR might not be an index of malignancy. [ABSTRACT FROM AUTHOR]

Mullerian adenosarcoma of the uterus is a biphasic tumor exhibiting benign epithelial and malignant stromal component. This tumor may occasionally be associated with tamoxifen therapy which is used as an adjuvant drug for breast carcinoma. Reviewing the literature, we found only 12 adenosarcoma cases associated with tamoxifen therapy Thus, the clinical and pathological findings in a 58 years old postmenopausal woman who developed uterine adenosarcoma, following low dose tamoxifen therapy after 8 years, was discussed in this report. [ABSTRACT FROM AUTHOR]