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Purpose & Methods: We report a case of a 42-year-old multigravida, premenopausal woman with breast carcinoma, who presented after four years of use of adjuvant tamoxifen with synchronous liver, bone, and lung metastasis of breast cancer with müllerian adenosarcoma., Results: Immunohistochemical stains on the uterine tumor for estrogen and progesterone receptors showed positivity for both epithelial and stromal cells, actin, and desmin while the proliferative index (MIB-1) showed positivity for stromal cells only. The patient underwent a hysterectomy followed by palliative chemotherapy. She died 14 months after her relapse because of progressive disease (cerebral, bone, liver and lung metastases)., Conclusion: Our case is the only one reported in the literature with synchronous relapse of breast adenocarcinoma and a Müllerian adenosarcoma. Moreover, it is one of the rare cases occurring in a premenopausal woman since all except two cases were postmenopausal.

Background: Mixed mullerian tumours are uncommon endometrial neoplasms that are composed by a combination of mesencymal elements and epithelial elements. They own their denomination to the mullerian origin of their components wich derive from the paramesonephric ducts. According to the benignity or the malignity of each component, four types of mixed mullerian tumours are individualised. Adenosarcoma is composed of benign glandular elements and sarcomatous, usually low-grade, stromal elements., Aim: We report a case of an endometrial adenosarcoma in a 59-year-old woman. Clinicopathological caracteristics and the etiopathogeny of this uncommun neoplasm will be discussed., Case: A 59-year-old women complained metrorrhagia assearated pair since three months. Vaginal examination showed an incresed valure. Copathological U.S and abdominer CT showed an important. No ather turner were detected hysterrchomy with dilated annexetny werre performed. Pathological examan concluded to tummor with animation of mesenchynal and le pthel elements

Fertility-sparing and minimally invasive surgeries are advancing everyday in gynecologic oncology. However, data on conservation of ovaries in uterine müllerian adenosarcoma are limited due to its very rare incidence in reproductive-aged females. Conservation of both ovaries along with adjuvant chemotherapy was performed in a 14-year-old girl with uterine adenosarcoma. After 30 months, she had no evidence of disease. Therefore, surgical conservation of ovaries might be a solution for fertility sparing in uterine müllerian adenosarcoma.

Background: Endometrial adenosarcoma is a rare tumor first described by Clement and Scully in 1974. It consists of benign or atypical neoplastic glands within a sarcomatous stroma and represents approximately 8% of all uterine sarcomas. Patients of a variety of ages are affected: the largest series reported 100 cases in patients aged 14-89 years, with the median age at presentation 58 years. Other case reports identified on a literature search also describe patients within this age range. The typical presentation is symptoms of abnormal vaginal bleeding. On examination, tissue protruding from the external cervical os is a common finding, with a smaller number of patients having an enlarged uterus or palpable pelvic mass. The standard management is total abdominal hysterectomy and bilateral salpingo-oophorectomy. However, difficulty arises when one is faced with this condition in a young nullipara wishing to preserve her fertility., Case: Endometrial polyp adenosarcoma occurred in a 27-year-old, nulligravid woman who presented with intermenstrual and postcoital bleeding. She was managed conservatively but will require close followup subsequently., Conclusion: A clinical dilemma was encountered in the management of a young woman with endometrial polyp adenosarcoma because of the necessity to preserve her fertility.

Background: Mullerian adenosarcoma of the uterine cervix is a rare tumor seen in young women of reproductive age group. It presents as cervical polyps and is a low-grade malignancy with a tendency for local recurrence. Diagnosis can be difficult since it can easily be mistaken for benign polyps, both clinically and pathologically., Case: We present three cases of adenosarcoma of the cervix presenting as cervical polyps and review the clinical and pathological features of these tumors., Conclusion: Adenosarcoma of the cervix should be ruled out especially in women presenting with recurrent cervical polyps. A careful histological examination is mandatory, important prognostic factors being myometrial invasion and sarcomatous overgrowth. Distant metastasis is very rare and therapy can be tailored to suit patient's needs but long term follow-up is essential.

Müllerian adenosarcoma (MS) is a rare neoplasm of uterine cervix composed of benign epithelial and malignant stromal components. An aggressive variant of adenosarcoma, müllerian adenosarcoma with sarcomatous overgrowth (MASO) is extremely rare. The difference between MS and MASO is the pure high grade sarcoma features in MASO. In this report we present a MASO case, derived from uterine cervix of a 60 year-old-female patient presenting as a cervical polypoid mass, to our knowledge the second case of the English literature. In spite of sarcomatous overgrowth, high mitotic activity and huge tumor size of 12,5 cms, it displayed no myometrial invasion, vascular invasion and heterologous elements. The patient has been clinically free of disease for 14 months of follow up after total abdominal hysterectomy and bilateralsalpingo-oopherectomy. The difficulties in diagnosis and treatment of this entity will be evaluated in this report.

Adenosarcoma is considered as being a variety of mixed Müllerian tumor having a small grade of malignity. Present case refers to a perimenopause patient examined for a structure of bleeding endocervical polypoid. Diagnostic evaluation performed after biopsy revealed a cervical leiomyosarcoma followed by operation. The range of occurrence is interesting, having in mind positive and differential diagnosis problems that occurred.

Adenosarcoma is a rare uterine biphasic tumor composed of benign epithelial elements and a sarcomatous stroma. Although it is well described histologically, its cytological features are rarely mentioned in the literature. We describe a case of uterine adenosarcoma that was first detected by Papanicolau (Pap) smear. Numerous crowded clusters of spindle cells were present within a bloody background, as well as a few smaller, dyscohesive groups with cells showing high N:C ratio and oval to round nuclei with coarse chromatin and small nucleoli. A few nuclear grooves were identified. Adenosarcomas are rare lesions but should be considered in the differential diagnosis when spindled cells are noted in a pap smear., (Copyright 2006 Wiley-Liss, Inc.)

Background: Uterine Mullerian adenosarcoma (UMA) is a rare and low-grade variant of mixed mesodermal tumor. UMA recurrences including heterologous sarcomatous elements are extremely rare, with only 3 cases reported thus far., Case: We present a case of UMA recurring as heterologous sarcoma three times in 8 months for 9.4 years after primary treatment. The number and grade of sarcomatous components increased with each recurrence eventually resulting in loss of the patient., Conclusion: The presence of multiple sarcomatous elements of high histological grade in the recurrent tumor following UMA may indicate an unfavorable prognosis with common recurrences and fatal outcome. All UMA patients carry risk of late recurrence, therefore, they should receive long-term follow-up.

Background: : The low incidence of ovarian adenosarcomas explains the paucity of available data regarding their biologic markers. Our aim was to investigate the presence of CD10, estrogen and progesterone receptors (ER and PR) in these tumors., Case: : Four cases of primary ovarian adenosarcoma were retrieved in our pathology databases. We assessed the immunohistochemical stainings for ER, PR and CD10 in 3 ovarian adenosarcomas without sarcomatous overgrowth (OAS), and 1 ovarian adenosarcoma with sarcomatous overgrowth (OAS-S). When considering the malignant stromal component, 2 OAS showed the presence of ER and PR, whereas the OAS-S was only ER positive. CD10 positivity was observed in the sarcomatous cells of all 3 OAS but was absent in the OAS-S., Conclusion: : The identification of a hormone sensitive disease is the main clinical implication of this study. Moreover, the current results add OAS to the list of CD10 positive ovarian tumors.

A case of gastrointestinal stromal tumor (GIST) with an unusual glandular component is reported. The tumor was found in the gastric fundus of a 93-year-old woman. Histologically, the lesion showed a biphasic adenosarcoma-like structure. Typical low-grade spindle cell patterns of GIST were intermingled with numerous and partly cystic glands. The glandular epithelium had pyloric/foveolar-like appearance, with foci of intestinal metaplasia and low-grade dysplasia. The stromal component was immunoreactive for CD117 (c-kit) and CD34, and negative for myoid and neuroid markers. The ultrastructural examination found nondescript and undifferentiated spindle cells. The gastric mucosa and submucosa near the tumor contained a small area with features of gastritis cystica profunda, with glands similar to those present inside the tumor. Therefore, a collision of GIST and gastritis cystica profunda is suggested in the histogenesis of the lesion.

Persistent müllerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism. Bilateral fallopian tubes and a uterus occur with an otherwise normal male phenotype. Testicular neoplasm in PMDS has been reported, but malignant degeneration of the remnant female genitalia has only once been reported. We present imaging, surgical specimen, and surgical pathology of the first documented case of uterine adenosarcoma of a müllerian remnant in a 14-year-old boy with PMDS presenting with gross hematuria and increasing abdominal protuberance. The child died of metastatic disease after surgical resection.

Primary peritoneal adenosarcoma with sarcomatous overgrowth and fetal-type cartilage presented in a 48-year-old female patient is described. The tumor seems likely to have derived from the pelvic peritoneum, wheareas the uterus, ovaries and tubes were uninvolved. It was composed of benign-appearing glands and a sarcomatous component showing cartilaginous differentiation. The extrauterine adenosarcomas were reported in other sites, e.g. cervix, ovary, fallopian tube, bladder, and peritoneum. This case was the ninth case of the primary peritoneal adenosarcoma in the English literature and the first report in Thailand.

Adenosarcoma of the uterus has two components: a benign epithelial proliferation and a stromal sarcoma. The purpose of this work was to report the clinical aspects and therapeutic modalities of an exceptional case of uterine adenosarcoma in a 15-year-old girl revealed by pelvic pain. Physical examination disclosed a polypoid formation protruding through the hymenal orifice. Histology of the mass confirmed the diagnosis of adenosarcoma of the uterus. The patient underwent hysterectomy and was given chemotherapy. This rare tumor (8% of uterine sarcomas) generally requires hysterectomy. Prognosis is relatively favorable.

Extrauterine mullerian adenosarcoma is rare and is thought to arise from endometriotic deposits or pluripotent mesothelial and mesenchymal cells of the pelvic cavity. Concomitant colon-rectal neoplasm was reported but the relationship between extrauterine adenosarcoma and colon tumor was not studied. We describe an extrauterine adenosarcoma with a concomitant rectal tubulovillous adenoma. The patient had a long-term history of endometriosis and unopposed estrogen therapy. Immunohistochemical study was performed to investigate the origin and nature of the adenosarcoma. Immunostaining provided the evidence to distinguish between rectal tumor and adenosarcoma. Extrauterine adenosarcoma may arise from endometriosis, and hormone replacement therapy may have some role in the malignant transformation process. Adenosarcoma should be considered in the differential diagnosis of a new pelvic tumor in a patient with a history of endometriosis.

Biphasic neoplasms with a benign to atypical epithelial component and a usually low-grade malignant stromal component have been reported in various sites, probably being best known for their occurrence in the uterine corpus (mullerian adenosarcoma). We report a tumor of this type that occurred in the testis of a 76-year-old man and, to our knowledge, is the first mesodermal adenosarcoma reported at this site. The patient had scrotal swelling for many years with a pronounced increase in the swelling over the past 2 years. A large complex solid-cystic testicular tumor was evident on ultrasound, and examination of a radical orchiectomy specimen showed a 6.5-cm mass. On microscopic examination, the neoplasm had a phyllodes-like appearance with bland cuboidal to flattened epithelium covering polypoid fronds, and lining glands and cysts. The stroma varied from cellular, particularly where it condensed around the glands and cysts, to hypocellular and hyalinized. It was immunoreactive for muscle specific actin, CD10, and to a lesser degree, desmin. This case expands the known sites where mesodermal adenosarcoma may occur. The histogenesis is speculative, but possible options are discussed.

Study Objective: To emphasize the need for histologic evaluation of intrauterine lesions. Six cases of unexpected mesenchymal uterine tumors were diagnosed following pathologic review of specimens obtained during hysteroscopy to evaluate intrauterine lesions., Design: Retrospective chart review (Canadian Task Force classification II-3)., Setting: Large tertiary care medical center., Patients: Four postmenopausal and two perimenopausal women with uterine mesenchymal tumors., Intervention: Hysteroscopy and staging laparotomy., Measurements and Main Results: Mean age of the patients was 57.5 +/- 19.5 years (mean +/- 2SD). Four women (67%) were postmenopausal. Three patients had abnormal uterine bleeding, one had a cervical mass, and the other two were asymptomatic and referred for evaluation of thick endometrium detected by routine ultrasound, which had been preformed as part of their annual check-up. In all cases, the initial hysteroscopic diagnosis was endometrial polyp or submucous myoma. Following the pathologic review, all six women underwent complete staging laparotomy. In two women, there was no residual disease in the surgical specimen. None of the patients had extrauterine spread of the disease. At mean follow-up of 21.5 +/- 9.7 months (mean +/- 2SD), all women were asymptomatic., Conclusions: Intrauterine lesions erroneously considered to be benign endometrial polyps or myomas can turn out to be malignant mesenchymal uterine tumors. Hysteroscopic evaluation and biopsy might offer early diagnosis and treatment to these patients.

A 83-year-old woman received bilateral salpingo-oophorectomy and hysterectomy due to a provisional diagnosis of ovarian cystic tumor. The tumor had a unilocular cystic cavity demonstrating serous cystadenoma and a solid mural nodule representing a biphasic pattern with mesenchymal and glandular components. The glandular elements were composed of benign serous cells, whereas the mesenchymal components consisted of an admixture of fibromatous stromal cells without atypia and sarcomatous overgrowth. The area of transition from a fibromatous component to sarcomatous overgrowth was identified. After a 2-year follow-up, there were no signs of tumor recurrence or systemic disease. To the authors' knowledge, this is the first reported case of adenofibrosarcoma originating from a mural nodule of ovarian serous cystadenoma.

Background: Primary vaginal adenosarcomas are extremely rare, and typical adenosarcomas are of low malignancy. However, aggressive forms with sarcomatous overgrowth have been reported, those appear to have a poor prognosis., Case: A 52-year-old woman who had undergone prior surgery for uterine leiomyoma and an ovarian cyst (total abdominal hysterectomy and left salpingo-oophorectomy) presented 10 years later with a rapidly enlarging tumor arising from the vaginal cuff. Repetitive biopsy samples revealed a mixture of benign epithelial gland and malignant stromal components with periglandular stromal hypercellularity and sarcomatous overgrowth. A histological diagnosis of mullerian adenocarcinoma was made. The patient died from recurrent disease 9 months after surgery., Conclusion: Regardless of primary focus, adenosarcoma with sarcomatous overgrowth is associated with postoperative recurrence and a fatal outcome.

Uterine adenosarcoma (UAS) is microscopically characterized by a biphasic growth pattern. By definition, the epithelial component is benign, whereas the stromal component typically has the appearance of a low-grade sarcoma, usually an endometrial stromal sarcoma. CD10 acts by reducing cellular response to peptide hormones and is currently regarded as a specific marker for endometrial stromal tumors. In this international multicenter study, we further explored CD10 immunoreactivity in 30 UASs. We encountered CD10 positivity of the sarcomatous component in 18/20 (90%) of UASs, in five of eight (63%) of UASs with sarcomatous overgrowth as well as in both cases of recurrent UAS. The epithelial component stained negative in all cases. These findings suggest that CD10 can be used to differentiate UAS from cellular leiomyoma, or in case endometrial stromal cells exhibit muscle differentiation. Furthermore, CD10 positivity in recurrent UAS might guide the pathologist toward an endometrial stromal origin.

We present a case of a liver endometrioma in a postmenopausal woman. After failed management with leuprolide acetate, the mass was resected and contained focal areas of mullerian adenosarcoma. This is a rare case of mullerian adenosarcoma that appeared to arise within an endometrioma of the liver.

An aggressive variant of adenosarcoma, mullerian adenosarcoma with sarcomatous overgrowth (MASO) in the cervix is extremely rare. This variant contains obvious, high-grade sarcoma in addition to a low-grade form. In this report, we describe a case of MASO of the uterine cervix and review the clinical and pathological features of these tumors. The patient was a 37-year-old woman with a cervical polypoid mass, which was morphologically considered as a benign endocervical polyp. Microscopically, polypoid cervical mass showed diffuse and dense malignant spindle cell proliferation around the benign endocervical glands and also an area of markedly anaplastic and pleomorphic spindle cell proliferation, so called, sarcomatous overgrowth. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymph node dissection were performed. The patient has been followed-up and neither chemotherapy nor other adjuvant therapies have been administered. At present, she has been clinically free of disease for 9 months since she received surgery. It is extremely rare that MASO of the uterine cervix is presented in premenopausal woman. Gynecologists and pathologists should be aware of the difficulties associated with a delay in the diagnosis of MASO when the tumor is present as a benign looking cervical polyp.

Background: Given the paucity of data regarding hormone dependency, it was the purpose of this study to screen for the presence of estrogen and progesterone receptors in uterine adenosarcoma (UAS)., Methods: One hundred and five centers were asked to screen their files for uterine adenosarcomas. A immunohistochemical estrogen and progesterone receptor determination was performed., Results: Twenty-eight primary UAS were stained, including one cervical adenosarcoma. Sarcomatous overgrowth could be observed in eight. Furthermore, two cases of recurrent UAS, one only consisting of endometrial stromal sarcoma, were stained. UAS lacking sarcomatous overgrowth showed estrogen receptor positivity in 17/20 (85%) and 16/20 (80%) in the epithelial and sarcomatous component, respectively. Progesterone positivity was observed in 13/20 (65%) and 12/20 (60%) in the epithelial and sarcomatous component, respectively. In 18/20 (90%) of the cases, either the estrogen or the progesterone receptor stained positive in the sarcomatous component. UAS with sarcomatous overgrowth showed estrogen receptor positivity in 4/8 (50%) and 0/8 (0%) in the epithelial and sarcomatous component, respectively. Progesterone positivity was observed in 2/8 (25%) and 1/8 (12%) in the epithelial and sarcomatous component, respectively. The stromal component of both recurrent cases stained moderately positive for estrogen receptor whereas progesterone receptor was considered negative., Conclusion: The observation that the sarcomatous component of UAS without sarcomatous overgrowth frequently expresses hormone receptors might be of significant clinical importance.

Objective: To present a rare case of endometrial stromal sarcoma arising in endometriosis of the rectovaginal septum., Design: Case report., Setting: Academic tertiary referral center for endometriosis treatment., Patient(s): A 50-year-old woman with a history of endometriosis presented with catamenial rectal pain and deep dyspareunia. Imaging findings suggested new endometriotic lesions in the rectovaginal space., Intervention(s): Total hysterectomy, salpingo-oophorectomy, and excision of the lesion in the rectovaginal septum were performed. Although extemporary pathology confirmed endometriosis, the final histologic diagnosis was extrauterine adenosarcoma in the rectovaginal septum. Two years later, recurrence of the malignancy occurred and was treated by resecting the new perirectal mass. Subsequent radiotherapy and chemotherapy were administered., Main Outcome Measure(s): Imaging findings at follow-up evaluation., Result(s): The patient was in good health for 2 years after the initial surgery, when she developed a new lesion at the site of the previous resection. The histologic appearance of the lesion was consistent with recurrence of the tumor. After postoperative therapy, the patient is now without evidence of disease., Conclusion(s): Malignant transformation of endometriosis should be considered in the differential diagnosis of a new pelvic lesion in a patient with a history of endometriosis.

Müllerian adenosarcoma is a distinctive type of mixed Müllerian tumor of the female genital tract. To our knowledge, no cytogenetic data have been documented on Müllerian adenosarcoma in the literature so far. We report here the chromosomal findings of a Müllerian adenosarcoma in a 15-year-old female. Cytogenetic and molecular cytogenetic analysis revealed a complex karyotype involving chromosomes 2, 8, 10, 13, 19, and 21. These numerical and structural abnormalities may be of etiologic significance. This report may highlight the potential value of molecular cytogenetic analysis in differential diagnosis of Müllerian tumors. More cases are warranted to further genetically characterize this type of neoplasm.

Adenosarcoma of the ovary is a rare condition. We report a case of a 32-year-old patient that has been treated in our Department. The diagnosis of ovarian adenosarcoma was carried out after laparoscopy with removal of an ovarian endometriotic cyst. Laparoscopic homolateral ovariectomy was then performed and conservative treatment was decided on considering the young age, low stage and low grade of the disease. Second-look laparoscopy, clinical evaluation and ultrasound were performed for four years of follow-up. No recurrence has been detected. Conservative treatment should be proposed in fertile age with low-grade ovarian adenosarcoma, but a strict follow-up is always necessary.

During the last 15-year period in our laboratory, 14 cases of malignant change of endometriosis were diagnosed in women 37-70 years of age. Seven cases were adenocarcinomas, one case was an adenosarcoma and six cases presented the morphology of endometrial stromal sarcoma. Eleven cases developed in various sites of the genital system (5/11 in the ovaries, 3/11 in the uterus 2/11 in the vagina, 1/11 in the tubal wall) and three cases in extragenital sites (1/3 in the omentum, 1/3 in the pelvis, 1/3 in the colon). Immunohistochemical investigation for the expression of cytokeratines, vimentin, hormonal receptors, E-cadherin, desmine and smooth muscle actin was performed by a streptavidin-biotin method. The immunopathology profile and follow-up results after therapy are presented.

Thirteen uterine tumors were diagnosed in 13 cats and accounted for 0.29% of all feline neoplasms received during a 9.6-year period. Age at diagnosis ranged from 3 to 16 years; median 9 years. Six were Domestic Shorthair cats, and 7 were purebred cats of 5 different breeds. Eight adenocarcinomas and 1 mixed Müllerian tumor (adenosarcoma) comprised the endometrial tumors. Myometrial tumors included 3 leiomyomas and 1 leiomyosarcoma. One of the adenocarcinomas developed in the uterine stump of an ovariohysterectomized cat; the other cats were sexually intact. Concurrent mammary adenocarcinoma was diagnosed in 1 cat with uterine adenocarcinoma and in another with uterine leiomyoma. Tumors were discovered during elective ovariohysterectomy in 2 cats, but at least 3 others had experienced reproductive problems (infertility or pyometra). Five cats presented for abdominal or pelvic masses. Endometrial adenocarcinomas were positive immunohistochemically for cytokeratins and negative for smooth muscle actin (SMA): 1 of 6 cats was positive for vimentin and 4 of 8 were positive for estrogen receptor-alpha (ER alpha). Adenosarcoma stromal cells were positive for vimentin and ER alpha but negative for cytokeratins and SMA. Smooth muscle tumors were positive for vimentin and SMA and negative for cytokeratins. Leiomyomas, but not the leiomyosarcomas, were positive for ER alpha. Adenocarcinomas in 4 cats had metastasized by the time of ovariohysterectomy. Two other cats were euthanized 5 months after ovariohysterectomy; at least one of these cats had developed an abdominal mass that was not examined histologically. Only 2 cats with endometrial adenocarcinoma had disease-free intervals longer than 5 months after surgery. Metastasis was not detected in any mesenchymal tumor; however, these cats were either euthanized on discovery of the tumor or the tumor was first detected at necropsy.

Background: Primary adenosarcoma arising in vaginal endometriosis poses a diagnostic challenge, especially in superficial vaginal biopsies., Case: A 56-year-old woman, with a prior diagnosis of ovarian endometriosis, presented with a rapidly enlarging mass of the vaginal vault. Two prior biopsies were benign and showed endometriosis. The third vaginal biopsy revealed benign endometriotic glands cuffed by a cellular stroma with moderate cytologic atypia, a histological appearance diagnostic of Müllerian adenosarcoma. A 16-cm vaginal mass that had infiltrated the pelvic structures was resected., Conclusions: Close clinical follow-up of extrauterine endometriosis and clinical-pathologic correlation is necessary. Histological features such as cellular stromal cuffing around benign endometriotic glands are critical in arriving at a timely diagnosis of adenosarcoma in patients with persistent extrauterine endometriosis, even in superficial vaginal biopsies.

Mullerian adenosarcoma is a neoplasm composed of benign mullerian epithelium and a sarcomatous stroma. This tumor classically occurs in the endometrium of postmenopausal women and less frequently in the extrauterine genital tract. Rare cases of extragenital adenosarcoma have been reported. We present the case of a 23-year-old female who presented with an extragenital adenosarcoma arising in an endometriotic cyst in the pouch of Douglas. The patient was treated with local excision, chemotherapy and radiotherapy. At 2 years follow-up she was disease-free. The literature on extragenital adenosarcoma is reviewed. These tumors are clinically more aggressive than their uterine counterparts. Surgical excision is the initial treatment modality for these patients. Little information is available regarding the efficacy of adjuvant chemotherapy or radiotherapy. This is an area that requires further study.

A serous carcinoma and endometrial intraepithelial carcinoma were encountered in an endometrial adenofibroma in a 61-year-old woman. The carcinoma involved the myometrium and cervix (stage IIa). To our knowledge, this is the third documented case of an adenocarcinoma and the first serous carcinoma involving a uterine adenofibroma.

The terminology of uterine sarcomas is confusing and has been inconsistently applied. The relationships among the various types of uterine sarcomas are unknown. To elucidate the relationship between carcinosarcoma (malignant mullerian mixed tumor) and adenosarcoma, a series of 26 consecutive endometrial carcinosarcomas was evaluated for the presence of an adenosarcoma-like component. Four of 26 carcinosarcomas (15%) had an adenosarcoma-like component. The clinical and pathologic features of these tumors were otherwise similar to ordinary endometrial carcinosarcomas. A histogenetic schema for uterine sarcomas is proposed, interrelating endometrial stromal sarcomas, adenosarcomas with and without sarcomatous overgrowth, and poorly differentiated sarcoma not otherwise specified. Although most carcinosarcomas are accepted as being metaplastic or sarcomatoid carcinomas, it is suggested that the carcinomatous component of 8% to 16% of carcinosarcomas arise within, or in the endometrium adjacent to, an adenosarcoma. This latter group is then integrated into the histogenetic schema. Observations based on our data and the limited data in the literature that support this hypothesis include: 13% of endometrial carcinosarcomas have gross and microscopic features of collision tumors, 13% have an adenosarcoma-like component, 16% have a low-grade stroma, and approximately 8% are biclonal indicative of a collision tumor. The most parsimonious interpretation of these data indicates that approximately 8% to 16% of endometrial carcinosarcomas arise because of malignant transformation of the epithelial component within, or in the endometrium adjacent to an adenosarcoma.

N. Sativa L., an oriental spice, has long been used as a natural medicine for treatment of many acute as well as chronic conditions. It has been used in the treatment of diabetes, hypertension, and dermatological conditions. There has been very few studies on the effects of N. Sativa as cancer prevention/therapy. Our objective therefore, was to expose MCF-7 breast cancer cells to aqueous and alcohol extracts and in combination with H2O2 as an oxidative stressor. Measurement of cell survival under various concentrations and combinations was conducted using standard cell culture techniques, exposure protocols in 96 well plates and Fluoro-spectrosphotometry. Following cellular growth to 90% confluency, exposure to water (WE) and ethanol (AE) extracts of N. sativa and H2O2 was performed. Toxicity index (LC50) was calculated from percent survival using regression analysis. Results showed that the alcohol extract and its combinations were able to completely inactivate the MCF-7 cells (LC50 ranged from 377.16-573.79 in descending potency for H2O2 + AE, AE and Mix of WE and AE). H2O2 alone effectively inactivated MCF-7 cells (LC50 = 460.94). The least effective combinations in descending potency were WE + H2O2, WE + AE + H2O2, and WE (LC50 were 725.79, 765.94, and 940.5 respectively. Combinations other than AE + H2O2 showed possible interactions, which lead to reduction in their potency. In conclusion, N. Sativa alone or in combination with oxidative stress were found to be effective in vitro in inactivating MCF-7 breast cancer cells, unveiling opportunities for promising results in the field of prevention and treatment of cancer.

A case of müllerian adenosarcoma with sarcomatous overgrowth in a postmenopausal 66-year-old female patient after adjuvant tamoxifen treatment for breast carcinoma is described. The patient was asymptomatic and the neoplasm was detected by pelvic sonography. The diagnosis was based on the histological findings after curettage and complementary total hysterectomy with bilateral salpingo-oophorectomy. The association of tamoxifen use and development of mesenchymal neoplasms is discussed.

Ovarian cancer strikes 23,000 American women every year, accounting for 52% of all gynecological cancer deaths. The death of comedienne Gilda Radner from ovarian cancer in 1991 brought the disease to the forefront for the American public. Unfortunately, since that time, there has been an absence of publicity about this dreadful disease. Seventy-five percent of ovarian cancers are not diagnosed until the cancer has advanced to stage III or IV for several reasons. Clinical guidelines for the diagnostic screening of ovarian cancer have not been developed, which markedly hinders the diagnosis of ovarian cancer until it is in later stages. The tumor marker CA-125 is not specific and, therefore, is an inadequate screening tool. This article discusses the epidemiology of ovarian cancer, the components of diagnostic screening, and treatment options. Nursing care of the patient undergoing surgical treatment for ovarian cancer also is discussed.

Objective: To report laparoscopic management of 15 patients with infiltrative bladder wall endometriosis and to report a case of endometrioid adenosarcoma., Design: Prospective chart review., Setting: Referral center for endometriosis., Patient(s): Fifteen women with infiltrating endometriosis of the bladder., Intervention(s): Laparoscopic segmental cystectomy and pathologic review of endometriotic bladder nodules in 15 patients., Main Outcome Measure(s): Location and characteristics of endometriotic bladder nodules., Result(s): Laparoscopic and cystoscopic evaluation confirmed that the endometriotic lesions were penetrating through the bladder wall. In 8 patients, the lesions were located in the dome of the bladder. In the remaining 7, the lesions were in the posterior wall, above the trigone. It was possible to treat all the lesions by performing a laparoscopic partial cystectomy. No intraoperative complications occurred. Deeply infiltrating endometriosis was confirmed on histologic evaluation in 14 cases. One patient was diagnosed with endometriosis on frozen section, but the final pathology revealed an adenosarcoma of the bladder., Conclusion(s): Surgical excision of deeply infiltrating endometriosis of the bladder wall can be performed laparoscopically and offers the benefit of a definitive pathologic diagnosis to rule out an occult malignancy.

Forty cases of mesodermal adenosarcoma of the ovary occurred in women 30-84 years of age (mean 54 years). Abdominal discomfort and distension were the usual complaints. All the patients were treated with an oophorectomy, which was accompanied by a hysterectomy in 85%, a contralateral oophorectomy in 65%, and nonsurgical therapy in 28%. Tumor rupture occurred at or before the operation in 67% of the cases. Twenty-six tumors were stage I, 11 stage II, and 3 stage III. The tumors were unilateral in 97.5% of the cases and 5.5-50 cm (mean 14 cm) in greatest dimension; most of the tumors were predominantly solid but contained numerous small cysts. Microscopic examination revealed sarcomatous overgrowth in 12 tumors. Sex cord-like elements were present in six tumors (including four with sarcomatous overgrowth) and heterologous elements in five (including two with sarcomatous overgrowth). The highest mitotic index of the sarcomatous component was 1-25 (mean 6) mitotic figures per 10 high power fields. Only 6 of 26 women (23%) who were followed postoperatively for > or=5 years were free of tumor. In the other 20 patients recurrent tumor appeared at 0.4-6.6 years (mean 2.6 years) after operation as pure sarcoma (low grade or high grade) or adenosarcoma (with or without sarcomatous overgrowth). Eight women had additional recurrences, and four women had blood-borne metastases. One patient was alive at 15.7 years after the excision of pulmonary metastases. The 5-, 10-, and 15-year survival rates were 64%, 46%, and 30%, respectively. Age <53 years, tumor rupture, a high grade, and the presence of high-grade sarcomatous overgrowth appeared to be associated with recurrence or extraovarian spread. Ovarian adenosarcomas have a worse prognosis than uterine adenosarcomas, presumably because of the greater ease of peritoneal spread. Many of the tumors caused problems in differential diagnosis.

In this report, we describe a case of adenosarcoma of the uterine corpus with overgrown and poorly differentiated sarcoma. The patient was an 80-year-old Japanese woman with abnormal genital bleeding. The endocervical biopsy showed undifferentiated carcinoma, and a cytologic examination at that time revealed the presence of cell types ranging from dispersed spindle to round atypical cells, suggestive of mesenchymal origin. The resected uterus had a polypoid mass in the corpus of the uterus and a solid white mass with the appearance of frank malignancy in the endocervix. The phyllode pattern was evident in the polypoid lesion and a diagnosis of adenosarcoma with sarcomatous overgrowth was made. The epithelial component was atypical with occasional microinvasion, which mimicked rhabdomyoblasts, but was easily identified as microinvasion by positive staining for epithelial, but not myogenic, markers. This case stresses the importance of the cytologic smear in the identification of frank sarcoma in an adenosarcoma, and it furthermore highlights the usefulness of immunohistochemistry in the distinction of epithelial microinvasion from rhabdomyogenic differentiation.

Background: Sarcomatous neoplasms of the uterine corpus are still a challenge in terms of obtaining prognostic factors and the most optimum complementary treatment to surgery. The most important prognostic factor is stage; relapses usually appear during the first 2 years, and most patients die within the first 3 years. We have performed a multivariate study of prognostic factors, stratifying patients by stage, to determine their impact on overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival. Special emphasis has been given to vascular and lymphatic space invasion (VLSI)., Methods: Sixty patients diagnosed with uterine neoplasms with a main sarcomatous component were treated at Hospital Clínic i Universitari of Barcelona between January 1975 and June 1999. Pathologic type: 32 carcinosarcomas, 14 leiomyosarcomas, 9 adenosarcomas, and 5 endometrial stromal sarcomas., Treatment: 58/60 surgery, 35/60 postoperative radiotherapy, 2/60 exclusive chemotherapy, and 3/60 complementary chemotherapy. FIGO stages: 43 Stage I, 4 Stage II, 11 Stage III, and 2 Stage IV. Variables analyzed: age, stage, vascular and lymphatic space invasion, myometrial invasion, mitotic index, tumor size, unicentricity/multicentricity, necrosis, and radiotherapy., Statistics: the S and Cox proportional risk models. The partial effect of each risk factor was calculated by hazard ratio (HR) with a confidence interval of 95%., Results: Early stages: Multivariate analysis showed that tumor size larger than 8 cm and VLSI had an impact on overall survival (HR = 4.01 and HR = 24.45, respectively). VLSI was present in 23% of the cases. Myometrial invasion greater than 50% had an impact on disease-free survival and local relapse-free survival (HR was 9.75 and 3.20, respectively). VLSI had an impact on distant metastasis-free survival (HR = 2.92). Advanced stages: VLSI was present in 89% of the cases. Only leiomyosarcoma type made the overall survival worse (HR = 10.54)., Conclusions: Vascular and lymphatic space invasion was a relevant prognostic factor in our series, with an impact on overall survival and distant metastasis-free survival in early stages. In advanced stages, VLSI had no impact on survival, but was present in 89% of cases. Myometrial invasion >50% had an impact on local relapse. Advanced stages had a more aggressive behavior, and there was a higher incidence of poor prognostic factors in these stages. Nevertheless, prospective studies are still needed on prognostic factors and on the best treatment option.

Atypical stromal cells of the lower female gynecologic tract have been specifically described in the vagina, vulva, and cervix, predominantly in the context of polyps. Rare cases of atypical stromal cells have been documented in the endometrium. We report a series of 15 examples of atypical stromal cells in the endometrium: 13 in endometrial polyps and two within endometrial stroma in curettage/biopsy specimens unassociated with polyps. The patients ranged in age from 45 to 82 years. Immunohistochemical studies were performed to aid in the identification of the origin of these atypical cells. The differential diagnoses included adenosarcoma, endometrial stromal sarcoma, and, less likely, malignant mesodermal mixed tumor (MMMT/carcinosarcoma). Similar to atypical stromal cells reported in other gynecologic sites, such cells discovered in the endometrium also appear to have a benign clinical course after complete excision or polypectomy (follow-up ranging from 1 month to 44 months). Accurate recognition of this lesion is essential to avoid unnecessary surgical overtreatment. Because of their rarity, limited available data, and lack of significant long-term follow-up, continued clinical monitoring of these patients would be prudent.

We report a primary peritoneal mullerian adenosarcoma with sarcomatous overgrowth associated with endometriosis in a 50-year-old female. The tumor formed multiple peritoneal masses occupying the pelvis and subdiaphragmatic space. Histologically, the tumor was composed of benign-appearing mullerian glands surrounded by a sarcomatous stroma. In addition, one perisplenic mass was largely devoid of the epithelial component and was of higher grade than the remaining lesions. Multiple foci of endometriosis were associated with the pelvic masses. To our knowledge, primary peritoneal mullerian adenosarcoma with sarcomatous overgrowth associated with endometriosis has not been previously reported.

Background: Müllerian adenosarcoma (MA) is a rare neoplasm composed of benign epithelial and malignant stromal components. Its location in the cervix and the presence of heterologous elements are extremely infrequent (to our knowledge, only 14 more cases have been reported in the English literature). We describe another case of MA of the uterine cervix with heterologous elements and review the clinical and pathological features of these tumors., Case Report: A nulliparous 25-year-old woman was admitted to the hospital because of metrorrhagia and recurrent masses, dependent on the cervix, initially considered endocervical polyps. Microscopically, the last curettage performed revealed a tumor composed of two elements, epithelial and mesenchymal. The epithelial elements were benign endocervical type glands, and the mesenchymal were sarcomatous, containing minor foci of cartilage. A diagnosis of endocervical heterologous adenosarcoma was reached, and a total hysterectomy and bilateral salpingo-oophorectomy were performed. The patient is alive 2 years after the surgical procedure. Neither chemotherapy nor other adjuvant therapies have been administered, and she is clinically free of disease at the moment., Conclusion: Because MA with heterologous elements seems to appear at the earliest stages of the reproductive lifespan in women, commonly with a history of recurrent polyps, and because its malignant potential is uncertain, gynecologists and pathologists should be aware and think about the possibility of this tumor. Long-term follow-up is essential and so is the accumulation of individual cases to provide further experience with these unusual neoplasms.

The aim of this study was to determine whether the expression of cyclooxygenase-2 (COX-2) in uterine sarcoma cells and carcinosarcoma cells is associated with cell type. Nineteen sections of tissues from uterine sarcomas, carcinosarcomas, and an adenosarcoma, and endometrial stromal sarcomas, were immunohistochemically analyzed for the cellular expression of COX-2. Positive immunostaining for COX-2 was observed in 88.9% (8/9) uterine carcinosarcomas, uterine adenosarcomas but was not observed in uterine sarcomas and the endometrial stromal sarcoma (0/10). But positive immunostaining for COX-2 was observed in some sarcomatoid cells in carcinosarcoma tissue. These findings suggest that some of the sarcoma cells in uterine carcinosarcomas resemble epithelial malignant cells in regard to the increase in COX-2 expression, and support the hypothesis that some uterine carcinosarcomas are combination tumors. This may serve as a basis for new chemoprevention and treatment strategies for uterine carcinosarcomas through the inhibition of COX-2 activity.