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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] [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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2
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Fadavi P, Garousi M, Soltani S, Montazer F, Abolhasani M, Asgari S, Mirzaee E. The uterine adenosarcoma with postoperative residual in a woman treated by total abdominal hysterectomy/bilateral salpingo-oophorectomy: A case report and review of literature. Cancer Rep (Hoboken) 2023; 6:e1891. [PMID: 37592402 PMCID: PMC10598255 DOI: 10.1002/cnr2.1891] [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: 04/04/2023] [Revised: 07/09/2023] [Accepted: 07/22/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND In patients with uterine adenosarcoma, a total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) is typically recommended as an initial treatment. There is no consensus on adjuvant therapies. CASE We report the case of a patient with uterine adenosarcoma with postoperative residual disease. We performed four courses of adjuvant chemotherapy, including Ifosfamide, Mesna, and Adriamycin, and whole pelvic radiation with a dose of 50.4 Gy/28 Fr. CONCLUSION A combination of chemotherapy and radiotherapy may be a promising treatment option for uterine adenosarcoma with postoperative residual disease.
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Affiliation(s)
- Pedram Fadavi
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Maryam Garousi
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Sepideh Soltani
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
| | - Fatemeh Montazer
- Department of Pathology, School of MedicineIran University of Medical SciencesTehranIran
| | - Maryam Abolhasani
- Oncopathology Research Center, School of MedicineIran University of Medical SciencesTehranIran
| | - Salar Asgari
- Department of Pathology, School of MedicineIran University of Medical SciencesTehranIran
| | - Elahe Mirzaee
- Department of Radiation Oncology, School of MedicineIran University of Medical SciencesTehranIran
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3
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Zhu X, Peng C, Huang Y, Zhou Y. Uterine cervical Müllerian adenosarcoma possibly arising from ovarian cystadenofibroma: A case report and review of the literature. Front Oncol 2023; 12:1064851. [PMID: 36686813 PMCID: PMC9846607 DOI: 10.3389/fonc.2022.1064851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Uterine cervical Müllerian adenosarcoma (MA), a rare malignant tumor of the female reproductive organs, is composed of a benign epithelium and a low-grade 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.
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Affiliation(s)
- Xinxin Zhu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Chao Peng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yan Huang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yingfang Zhou
- Department of Obstetrics and Gynecology, Peking University First Hospital Ningxia Women and Children's Hospital (Ningxia Hui Autonomous Region Maternal and Child Health Hospital), Yinchuan, China,*Correspondence: Yingfang Zhou,
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4
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Akrivi S, Varras M, Anastasiadi Z, Pappa C, Vlachioti A, Varra VK, Varra FN, Balasi E, Akrivis C. Primary vulvar leiomyosarcoma localized in the Bartholin's gland area: A case report and review. Mol Clin Oncol 2021; 14:69. [PMID: 33680460 PMCID: PMC7890440 DOI: 10.3892/mco.2021.2231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 01/14/2021] [Indexed: 01/14/2023] Open
Abstract
Vulvar sarcomas located in the Bartholin's gland area are extremely uncommon mesenchymal vulvar tumors. These neoplasms can be mistaken as Bartholin' gland benign lesions such as cysts or abscesses, leading to a delay in the diagnosis of underlying malignancy. Currently, only a few cases of these aggressive cancers have been reported in the literature. A 42-year-old female patient without any previous complaint presented to Obstetrics and Gynecology Department of ‘G. Chaztikosta’ General Hospital due to a vulvar lump in the area of the left Bartholin's gland with a 6-month history of progressive swelling. Pelvic examination showed a solid mass of 6.5-cm in maximum diameter, localized in the left Bartholin's gland. The patient underwent wide local excision and histopathological examination of hematoxylin and eosin-stained sections indicated intersecting fascicles of spindle cells, with moderate to severe atypia. The number of mitoses was up to 8 per 10 high power fields. The neoplasm to its greatest extent was circumscribed and in places had an invasive growth pattern. Tumoral necrosis was not seen. Involved Bartholin' gland by the tumor was identified. The tumor extended focally to the surgical margin. The neoplastic cells showed positive staining for smooth muscle actin, desmin, HHF35, caldesmon, vimentin and estrogen and progesterone receptors. Immunohistochemistry was negative for S100, myoglobulin, keratin 116, CD117, CD34 and CD31. The patient denied further surgery or/and local radiotherapy, although the mass was >5-cm and a focally infiltrative surgical margin was found. During the close follow-up, no local recurrences or metastases were observed 53 months after surgery. In conclusion, wide local tumor excision with free surgical margins is a good option of surgery for vulvar leiomyosarcomas. In recurrences, a new extensive surgical resection of the lesion and radiotherapy are suggested. Ipsilateral lympadenectomy is indicated when there is a pathologic lymph node. Chemotherapy is provided in cases of distal metastases.
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Affiliation(s)
- Stella Akrivi
- Department of Obstetrics and Gynecology, Royal Jubille Maternity Hospital, Belfast Trust, Belfast BT12 6BA, UK
| | - Michail Varras
- Fourth Department of Obstetrics and Gynecology, 'Elena Venizelou' General Hospital, Athens 11521, Greece
| | - Zoi Anastasiadi
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | - Christina Pappa
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | - Aikaterini Vlachioti
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | | | - Fani-Niki Varra
- Department of Pharmacy, Frederick University, Nicosia 1036, Cyprus
| | - Eufemia Balasi
- Pathology Department, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
| | - Christos Akrivis
- Department of Obstetrics and Gynecology, 'G. Chatzikosta' General Hospital, Ioannina 45001, Epirus, Greece
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Lugo Santiago N, Groth J, Hussain N, Kothari R. Management and survival of patients with Mullerian adenosarcoma of the cervix without sarcomatous overgrowth desiring fertility preservation, a case report and review of the literature. Gynecol Oncol Rep 2019; 32:100525. [PMID: 32181315 PMCID: PMC7062919 DOI: 10.1016/j.gore.2019.100525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022] Open
Abstract
Cervical Mullerian adenosarcoma is a tumor that affects reproductively aged women. Hysterectomy had been the standard of care for these premenopausal women. This case reports the most minimally invasive approach with no recurrence. Accurate pathology interpretation is essential to diagnose and treat patients. This is a rare tumor that if misdiagnosed or mischaracterized could be lethal.
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Affiliation(s)
- Nicole Lugo Santiago
- University of Illinois at Chicago College of Medicine, 820 S Wood St M/C 808 Chicago, IL 60612, United States
| | - John Groth
- University of Illinois at Chicago College of Medicine, 820 S Wood St M/C 808 Chicago, IL 60612, United States
| | - Nuzhath Hussain
- University of Illinois at Chicago College of Medicine, 820 S Wood St M/C 808 Chicago, IL 60612, United States
| | - Rajul Kothari
- University of Illinois at Chicago College of Medicine, 820 S Wood St M/C 808 Chicago, IL 60612, United States
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6
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Frías-Sánchez Z, Pantoja-Garrido M, Gutiérrez-Domingo Á, Jiménez-Gallardo J, Polo-Velasco A, Rodríguez-Jiménez I. Adenosarcoma de alto grado de endocérvix y cavidad endometrial con componente heterólogo de rabdomiosarcoma. Reporte de caso y revisión de la literatura. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2019; 70:122-128. [PMID: 31613077 DOI: 10.18597/rcog.3258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 06/17/2019] [Indexed: 11/04/2022]
Abstract
Objective To present the case of a patient diagnosed with high grade adenosarcoma of the endocervix and the endometrial cavity, with a heterologous component, and to conduct a review of the literature focusing on the diagnosis and therapeutic management of this disease condition. Materials and methods We present the case of a 31-year-old female patient who came to Virgen Macarena University Hospital of Seville, a Level III regional institution, complaining of genital bleeding arising from an endocervical polypoid mass. The biopsy of the mass revealed a high grade, poorly differentiated leiomyosarcoma of the endocervix. The patient was taken later to total abdominal hysterectomy. The study of the surgical specimen provided the following result: adenosarcoma of the endocervix and endometrial cavity with a heterologous rhabdomyosarcoma component. A search was conducted in the Medline database via Pubmed using the terms "adenosarcoma," "endocervical," "cervix," "uterus," "heterologous." The search in- cluded literature review articles, case reports and clinical case series describing aspects of cervical adenosarcoma and the heterologous rhabdomyosar- coma component, published in English and Spanish since 1974. Results Six articles corresponding to literature reviews, case reports or case series in which the most relevant aspects of the diagnosis and treatment of this disease condition are described were retrieved. Conclusions This condition is characterized, on occasions, by rapid and aggresive growth, hence the importance of early diagnosis and optimal treatment based on a combination of surgery, radiation therapy and chemotherapy. However, due to its low prevalence, further studies are needed in order to confirm these data.
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Affiliation(s)
- Zoraida Frías-Sánchez
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen del Rocío, Sevilla (España)
| | - Manuel Pantoja-Garrido
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena, Sevilla (España)
| | | | - Julián Jiménez-Gallardo
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena, Sevilla (España)
| | - Alfredo Polo-Velasco
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena, Sevilla (España)
| | - Inmaculada Rodríguez-Jiménez
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena, Sevilla (España)
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7
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Mullerian adenosarcomas of the uterine cervix with sarcomatous overgrowth. Curr Probl Cancer 2018; 43:371-376. [PMID: 30522776 DOI: 10.1016/j.currproblcancer.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022]
Abstract
Mullerian adenosarcoma with sarcomatous overgrowth (MASO) of the uterine cervix is an extremely rare variant of adenosarcoma of the genital tract associated with aggressive clinical course. We searched the PubMed and Medline databases for MASO of the cervix and we identified and reviewed eleven cases published between years 2004 and 2017. The most common clinical picture includes abnormal vaginal bleeding, postcoital bleeding, pelvic pain and foul-smelling vaginal discharge. Therapeutic options for MASO are still undefined. Radical hysterectomy with sufficient tumour-free margins combined with adjuvant chemotherapy and radiotherapy should serve as an effective treatment tool with favourable outcome.
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Togami S, Kawamura T, Fukuda M, Yanazume S, Kamio M, Kobayashi H. Clinical management of uterine cervical mullerian adenosarcoma: A clinicopathological study of six cases and review of the literature. Taiwan J Obstet Gynecol 2018; 57:479-482. [DOI: 10.1016/j.tjog.2018.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 10/28/2022] Open
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9
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Uterine Adenosarcoma with Sarcomatous Overgrowth: A Case Report of Aggressive Disease in a 16-Year-Old Girl and a Literature Review. J Pediatr Adolesc Gynecol 2018; 31:426-431. [PMID: 29317258 DOI: 10.1016/j.jpag.2017.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/26/2017] [Accepted: 12/31/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Uterine adenosarcoma with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. A case of a 16-year-old girl with uterine ASSO is reported herein. The patient received surgical resection and chemotherapy and remained alive without disease 11 months after the surgery. CASE A 16-year-old girl was diagnosed with uterine ASSO, International Federation of Gynecology and Obstetrics (2009) stage I c. She underwent total abdominal hysterectomy, bilateral salpingectomy, and chemotherapy. She remains alive and there was no evidence of tumor recurrence on follow-up physical, laboratory, and ultrasound scan examinations. SUMMARY AND CONCLUSION Surgery is the primary treatment for uterine ASSO, total abdominal or laparoscopic-assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy are recommended. Early surgical resection might increase survival of uterine adenosarcoma. Long-term follow-up of the patients is recommended because of the high chance of recurrence.
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10
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Shinnick JK, Kumar N, Beffa L, Miller K, Friedman MA, Kalife E, DiSilvestro P, Mathews C. Management of Low-Grade Cervical Müllerian Adenosarcoma in a 14-Year-Old Girl. J Pediatr Adolesc Gynecol 2017; 30:652-654. [PMID: 28578185 DOI: 10.1016/j.jpag.2017.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Müllerian adenosarcomas of the cervix are composed of benign epithelial and malignant stromal components. The purpose of this report is to describe the clinical and histologic difficulties in diagnosis and to propose fertility-preserving management of low-grade lesions. CASE A 14-year-old girl presented with a friable lesion found to originate from the anterior cervical lip. Initially, clinical suspicion was for sarcoma botryoides, however, pathologic evaluation revealed a low-grade cervical Müllerian adenosarcoma. Cold knife conization was performed, and the mass was resected with clear margins. SUMMARY AND CONCLUSION Müllerian adenosarcoma of the cervix is difficult to diagnose in adolescents because of features more commonly associated with alternative diagnoses. For patients with low-grade lesions desiring future fertility, local excision with close follow-up is reasonable.
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Affiliation(s)
- Julia K Shinnick
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Natasha Kumar
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lindsey Beffa
- Department of Gynecologic Oncology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Katherine Miller
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mary Alexandra Friedman
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elizabeth Kalife
- Department of Pathology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paul DiSilvestro
- Department of Gynecologic Oncology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cara Mathews
- Department of Gynecologic Oncology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
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Koyuncuoğlu M, Saatli B, Yıldırım N. Ovarian metastasis of Müllerian adenosarcoma of the cervix with sarcomatous overgrowth. Turk J Obstet Gynecol 2017; 14:195-198. [PMID: 29085712 PMCID: PMC5651897 DOI: 10.4274/tjod.75735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/27/2017] [Indexed: 12/01/2022] Open
Abstract
The aim of this study is to present a rare case of Müllerian adenosarcoma of the cervix with ovarian metastasis and sarcomatous overgrowth. A gravida 2, para 2 woman aged 32 years with vaginal bleeding was admitted to the gynecology department. A 3-4 cm polypoid mass protruding from the cervix was detected in a pelvic examination. Total abdominal hysterectomy and bilateral salpingoopherectomy was performed because of metastatic implants on the right ovary. The pathologic evaluation revealed Müllerian adenosarcoma of the cervix with sarcomatous overgrowth and ovarian metastasis. After surgery, the patient was planned to undergo chemo- and radiotherapy. This is the first cervical Müllerian adenosarcoma case mentioned in the literature with metastasis to the ovary in a young woman. There is no optimal management option for cervical adenosarcomas due to the rarity of this phenomenon. Nevertheless, even if the patient is young and imaging techniques do not elucidate metastatic disease, surgeons should evaluate the ovaries for the spread of tumor, especially if histology reveals sarcomatous overgrowth.
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Affiliation(s)
- Meral Koyuncuoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Bahadır Saatli
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
| | - Nuri Yıldırım
- Ege University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
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12
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Abstract
Adenosarcomas are rare malignancies of the female genital tract, accounting for approximately 5 % of uterine sarcomas. Occasionally, adenosarcoma occurs in the ovaries or in extra-uterine tissue, which may be related to endometriosis. These tumors are characterized by benign epithelial elements and a malignant mesenchymal component. Pathologic diagnosis is dependent on the identification of the characteristic morphologic features. The most common immunohistochemical markers for adenosarcoma are CD10 and WT1, but these are not specific. The most frequent presenting symptom is abnormal uterine bleeding. The majority of patients present with stage I disease, with a 5-year overall survival of 60 to 80 %. Survival is influenced by the presence of myometrial invasion, sarcomatous overgrowth, lymphovascular invasion, necrosis, and the presence of heterologous elements including rhabdomyoblastic differentiation. Patients with sarcomatous overgrowth have significantly increased risk of recurrence 23 versus 77 % and decreased 5-year overall survival 50 to 60 %. Standard of care treatment is total hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy, as the incidence of lymph node metastasis is rare. Retrospective data does not support the use of adjuvant pelvic radiotherapy in uterine adenosarcomas as no survival benefit is seen. Insufficient data exists to recommend routinely neoadjuvant or adjuvant chemotherapy for uterine adenosarcomas. Limited evidence exists for the role of hormonal therapy in uterine adenosarcomas. The PIK3/AKT/PTEN pathway is mutated in ∼70 % of adenosarcomas, and this may represent a possible therapeutic target. This article reviews the current state of knowledge concerning uterine adenosarcoma and discusses the management of this rare tumor.
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Affiliation(s)
- Michael J Nathenson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Nicole Fleming
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Anthony Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
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13
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Case Report of Successful Childbearing after Conservative Surgery for Cervical Mullerian Adenosarcoma. Case Rep Obstet Gynecol 2017; 2017:4187416. [PMID: 28154764 PMCID: PMC5244008 DOI: 10.1155/2017/4187416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022] Open
Abstract
Mullerian adenosarcoma (MA) is a rare tumor variant with low malignancy potential and is reported to account for 8% of all uterine sarcomas. Cervical MAs are reported to occur in relatively younger patients with the mean age of 27 years, while those in the uterine corpus generally present in postmenopausal women. Due to the rarity of cervical MAs, optimal management for these patients (especially younger women) is still under exploration. Here, we describe a case of cervical MA in a woman of reproductive age who was treated by fertility-preserving surgery and successfully delivered a child 18 months later.
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14
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Morales F DA, Medina R ML, Trujillo LM, Beltrán MI, Dulcey IC. Müllerian adenosarcoma of the uterine cervix with sarcomatous overgrowth: A case report of aggressive disease in a young patient. Int J Surg Case Rep 2016; 27:155-161. [PMID: 27621097 PMCID: PMC5021815 DOI: 10.1016/j.ijscr.2016.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/29/2016] [Indexed: 11/21/2022] Open
Abstract
Cervical Müllerian adenosarcomas with sarcomatous overgrowth are rare and aggressive. Recurrence is more likely when less radical surgery is performed. Radiotherapy and ifosfamide and platinum chemotherapy may aid disease control.
Introduction Müllerian adenosarcoma of the cervix with sarcomatous overgrowth and lymphovascular invasion is a rare and aggressive disease. We report a case of a young patient with Müllerian adenosarcoma with sarcomatous overgrowth in the uterine cervix and pelvic lymph node involvement. The patient received radical surgery but not adjuvant treatment, and the disease was aggressive with rapid relapse. Presentation of case A 39-year-old woman was diagnosed with Müllerian adenosarcoma of the cervix with sarcomatous overgrowth, International Federation of Gynecology and Obstetrics (FIGO) stage IB2. She underwent abdominal radical hysterectomy and resection of the left external iliac lymph nodes for suspected metastatic involvement detected during surgical exploration but undetected via imaging. She refused adjuvant treatment, and the disease recurred 8 months after primary oncologic surgery, with rapid local, regional, and bone relapse. Discussion Our report suggests that sarcomatous overgrowth, a high mitotic index, a rhabdomyoblastic component, and lymphovascular compromise are risk factors for aggressive recurrence. Positron emission tomography-computed tomography (PET-CT) was used to identify relapse locations in addition to those detected via clinical examination of the vaginal vault. However, whether PET-CT is indicated for the initial detection of lymph node and bone metastases in FIGO stage IB tumors with surgical indication is unclear. Conclusion A young woman with Müllerian adenosarcoma of the cervix with sarcomatous overgrowth presenting the risk factors for its recurrence experienced a rapid relapse after receiving radical surgery but not adjuvant therapy. Control of this aggressive disease via sequential radiotherapy and chemotherapy are recommended.
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Affiliation(s)
- David A Morales F
- Department of Gynecologic Oncology, National Cancer Institute of Colombia (INC), Bogotá D.C., Colombia.
| | - Monica L Medina R
- Department of Gynecologic Oncology, National Cancer Institute of Colombia (INC), Bogotá D.C., Colombia
| | - Lina M Trujillo
- Department of Gynecologic Oncology, National Cancer Institute of Colombia (INC), Bogotá D.C., Colombia
| | - Maria I Beltrán
- Department of Pathologic Oncology, National Cancer Institute of Colombia (INC), Calle 1 # 9-85, Bogotá, Colombia
| | - Isabel C Dulcey
- Department of Pathologic Oncology, National Cancer Institute of Colombia (INC), Calle 1 # 9-85, Bogotá, Colombia
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15
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Podduturi V, Pinto KR. Mullerian adenosarcoma of the cervix with heterologous elements and sarcomatous overgrowth. Proc (Bayl Univ Med Cent) 2016; 29:65-7. [PMID: 26722175 DOI: 10.1080/08998280.2016.11929364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Cervical adenosarcomas are exceedingly infrequent tumors that occur most often in women of reproductive age. Adenosarcomas comprise benign epithelial elements and malignant stromal elements. The malignant stromal elements can either be homologous, such as fibroblasts or smooth muscle, or heterologous, like cartilage, striated muscle, or bone. We report a case of adenosarcoma of the cervix with heterologous elements and sarcomatous overgrowth in a 38-year-old woman.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas
| | - Karen R Pinto
- Department of Pathology, Baylor University Medical Center at Dallas
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16
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Chin PS, Chia YN, Lim YK, Yam KL. Diagnosis and management of Müllerian adenosarcoma of the uterine cervix. Int J Gynaecol Obstet 2013; 121:229-32. [PMID: 23490428 DOI: 10.1016/j.ijgo.2012.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 12/13/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report on the diagnosis and management of Müllerian adenosarcoma of the uterine cervix at a gynecologic oncology unit in Singapore. METHODS Nine cases (1992-2008) were identified from the unit registry. All hospital records were retrospectively analyzed. RESULTS Mean age at diagnosis was 45±12 years (range, 17-61 years). Presenting symptoms were abnormal vaginal bleeding (5 [55.6%] patients), introital mass (3 [33.3%] patients), and foul-smelling vaginal discharge (1 [11.1%] patient). Two (22.2%) patients were asymptomatic, with cervical polyps discovered incidentally on routine gynecologic check-up. All women had benign-looking cervical polyps and underwent polypectomy. Histology showed increased stromal cellularity with periglandular cuffs in all patients, and heterologous differentiation in 1(11.1%) patient. All 9 women had FIGO stage 1B disease. Seven (77.8%) patients underwent radical hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy. One (11.1%) woman underwent cervical wedge resection and 1 (11.1%) refused definitive surgery. There was no recurrence in the 6 patients for whom complete follow-up data were available. CONCLUSION Clinical diagnosis of Müllerian adenosarcoma of the uterine cervix may be challenging owing to the benign gross appearance of the cervical polyps. Surgery provides a good chance of cure with no recurrence.
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Affiliation(s)
- Pui-See Chin
- Department of Obstetrics and Gynecology, Kandang Kerbau Women's and Children's Hospital, Singapore.
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Mullerian adenosaroma of the cervix with sarcomatous overgrowth and heterologous elements presenting as a recurrent cervical polyp. Case Rep Obstet Gynecol 2012; 2012:358302. [PMID: 22953093 PMCID: PMC3431066 DOI: 10.1155/2012/358302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/19/2012] [Indexed: 11/18/2022] Open
Abstract
Mullerian adenosarcoma of the cervix is a rare tumor composed of benign epithelial and malignant stromal components. Sarcomatous overgrowth and heterologous elements in cervical adenosarcoma are extremely infrequent. We report the case of a 26-year-old woman admitted at the gynaecology department for a painless mass protruding from her vagina. The initial pathological exam concluded to endocervical polyp. Six months later, the patient was readmitted with a recurrence of the polyp. The pathological exam demonstrated interlacing fascicles of elongated spindle cells with few mitotic activity and no glandular formation. After reviewing of the initial polyp the diagnosis of mullerian adenosarcoma was suggested. A second recurrence of the polyp was noted one month later. Histopathological exam of the recurrent polyp confirmed the diagnosis of adenosarcoma with sarcomatous overgrowth and heterologous elements. The patient was lost for follow-up. Cervical adenosarcoma with sarcomatous overgrowth and heterologous element is a rare tumor that occurs in younger age in contrast to endometrium/corpus uterin mullerian adenosarcoma. In young women with recurrent cervical polyp, mullerian adenosarcoma must be considered and should be excluded by careful histopathological exam. Sarcomatous overgrowth and myometrial invasion are the most important prognostic factors. Treatment strategy is still unclear.
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Xie YP, Yao HX, Shen YM. Müllerian adenosarcoma of the uterus with heterologous elements: two case reports and literature review. Arch Gynecol Obstet 2012; 286:537-40. [PMID: 22382369 DOI: 10.1007/s00404-012-2258-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 02/16/2012] [Indexed: 11/29/2022]
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Patrelli TS, Gizzo S, Di Gangi S, Guidi G, Rondinelli M, Nardelli GB. Cervical Mullerian adenosarcoma with heterologous sarcomatous overgrowth: a fourth case and review of literature. BMC Cancer 2011; 11:236. [PMID: 21663687 PMCID: PMC3141764 DOI: 10.1186/1471-2407-11-236] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine sarcomas are relatively rare tumors that account for approximately 1-3% of female genital tract malignancies and between 4-9% of uterine cancers. Less than 8% of all cases are Mullerian adenosarcoma, a distinctive uterine neoplasm characterized by a benign, but occasionally atypical, epithelial and a malignant, usually low-grade, stromal component, both of which should be integral and neoplastic constituents of the tumor. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very aggressive variant, associated with post-operative recurrence, metastases, even when diagnosed in early stage. CASE PRESENTATION We present a fourth MASO case derived from uterine cervix in a 72-year-old woman with metrorrhagia and a polypoid mass protruding through the cervical ostium. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic lymph node dissection, omental biopsy and appendectomy were performed. Surgery treatment was associated with adjuvant whole-pelvis radiation (45 Gy) and adjuvant chemotherapy (cisplatin/ifosfamide). After nine months of follow up, the patient was free of tumor. CONCLUSIONS The rarity of MASO of the cervix involves a management difficult. Most authors recommend total abdominal hysterectomy, usually accompanied by bilateral salpingo-oophorectomy. There is no common agreement on staging by lymphadenectomy during primary surgery and adjuvant chemo-radio therapy.
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Affiliation(s)
- Tito Silvio Patrelli
- Department of Gynecological and Human Reproduction Sciences, University of Padua, via Giustiniani 3, 35128 Padua, Italy
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Adenosarcoma of the uterine cervix with heterologous elements: a case report and review of literature. Arch Gynecol Obstet 2009; 281:669-75. [PMID: 19685064 DOI: 10.1007/s00404-009-1200-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 07/26/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Adenosarcoma of the uterus is a rare tumor composed of benign epithelial and malignant stromal components, usually encountered in young women. Till date, more than 100 cases of mullerian adenosarcoma of the cervix with homologous elements have been reported. However, only 15 cases of mullerian adenosarcoma of the cervix with heterologous elements are reported. MATERIALS AND METHODS We describe a case of mullerian adenosarcoma with heterologous elements of rhabdomyosarcoma and benign cartilage presenting as a cervical polyp in a young girl. The clinicopathological features and management of this rare entity is reviewed. CONCLUSION Cervical adenosarcomas are rare tumors that may appear in reproductive age. Optimal therapy is still unclear, and a long-term follow-up is essential. Such cases need to be reported as accumulation of individual cases will be able to provide knowledge about its optimal therapy and prognosis.
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Fleming NA, Hopkins L, de Nanassy J, Senterman M, Black AY. Mullerian adenosarcoma of the cervix in a 10-year-old girl: case report and review of the literature. J Pediatr Adolesc Gynecol 2009; 22:e45-51. [PMID: 19493521 DOI: 10.1016/j.jpag.2008.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 06/03/2008] [Accepted: 06/06/2008] [Indexed: 10/20/2022]
Abstract
UNLABELLED Müllerian adenosarcoma is a rare neoplasm usually found in postmenopausal women. It usually presents as a polypoid mass within the endometrium. It is a biphasic tumor, composed of a benign epithelial component and a malignant stromal component. To date, this neoplasm has been reported in only 16 adolescent girls. We present a case of a 10-year-old girl who was diagnosed with müllerian adenosarcoma arising from the endocervix, the youngest female ever reported. CASE REPORT A 10-year-old previously healthy girl presented to the Emergency Department at the Children's Hospital of Eastern Ontario with a painless mass protruding from her vagina. She had experienced mild vaginal bleeding for two weeks prior to her presentation. On physical examination, her vital signs were stable, and pubertal development was Tanner III breast and Tanner II pubic development. Rectoabdominal examination was negative. Two polypoid lesions were seen protruding past the hymenal ring and were removed in the emergency department. On gross examination, they were a dark tan color and had a fleshy appearance with a gelatinous consistency. They measured 5.5 x 1.5 x 1.0 cm and 3.5 x 1.5 x 1.5 cm. The final pathology revealed müllerian adenosarcoma, favoring an endocervical origin. Further investigations, including an abdominal/pelvic ultrasound and MRI and chest radiography, were negative. The patient subsequently underwent examination under anesthesia, vaginoscopy, hysteroscopy, polypectomy, and dilatation and curettage. The vagina appeared normal. At the level of the cervix, there were 3 polypoid gelatinous structures arising from the endocervix and extruding past the exocervix. They measured 0.8 x 0.5 x 0.2 cm up to 1.1 x 0.7 x 0.5 cm. The lesions were removed. Hysteroscopic inspection of the uterine cavity did not find any abnormalities. An endometrial curettage was performed. Pathology confirmed a diagnosis of müllerian adenosarcoma originating from the endocervix. Uterine curettings were negative for malignancy. After a thorough evaluation of the available literature, review with the Regional Tumor Board and extensive discussions with the family, a decision was made to perform a radical hysterectomy, bilateral salpingectomy, bilateral pelvic lymph node dissection, upper vaginectomy and preservation of ovaries. The procedure was uncomplicated. Clinically, there was no evidence of residual disease. The final pathology was negative for malignancy. CONCLUSION Müllerian adenosarcoma of the endocervix is a very rare pediatric tumor. Due to the rarity of this tumor in this age group, optimal therapy is uncertain. Most experts recommend hysterectomy. The review of literature reveals a high recurrence rate following conservative surgical management. Chemotherapy and radiation have not been used in the absence of extensive pelvic and/or residual disease. Poor prognostic factors include depth of invasion, sarcomatous overgrowth and high-grade malignant features in the stromal component. If recurrence occurs, it tends to be local and following prior conservative treatments such as cone biopsy or trachelectomy. Recurrences may occur late and thus long term follow-up of these patients is recommended.
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Affiliation(s)
- Nathalie A Fleming
- Division of Gynecology, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Rd, Ottawa, ON K1H 8L1, Canada.
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Mumba E, Ali H, Turton D, Cooper K, Grayson W. Human papillomaviruses do not play an aetiological role in Müllerian adenosarcomas of the uterine cervix. J Clin Pathol 2008; 61:1041-4. [PMID: 18552169 DOI: 10.1136/jcp.2008.056614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To determine if human papillomaviruses (HPVs) play a role in the histogenesis of adenosarcomas of the uterine cervix. METHODS Nine archival cases of primary cervical adenosarcoma were studied. The HPV status of the nine histologically proven tumours was investigated by non-isotopic in situ hybridisation (NISH) and PCR. NISH was performed using digoxigenin labelled probes to HPV types 6, 11, 16, 18, 31 and 33. PCR used GP5+/GP6+ primers to the HPV L1 gene. RESULTS Neither the benign epithelial components nor the malignant stromal components of the 9 neoplasms harboured nuclear NISH signals for the HPV types investigated. Amplimers of the HPV L1 gene were not detected by PCR in any of the tumours studied. CONCLUSION HPVs do not appear to play an aetiological role in cervical adenosarcomas. This suggests that a different histogenetic pathway for this rare tumour type must exist.
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Affiliation(s)
- E Mumba
- Division of Anatomical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg and the National Health Laboratory Service, Republic of South Africa
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Abstract
The role of MR imaging in the diagnosis and management of patients who have uterine malignancy continues to evolve. MR imaging has been shown to be effective for preoperative characterization and staging of endometrial and cervical carcinoma, and for the evaluation of posttreatment changes and recurrent disease. Because of its potential to provide detailed information about local extent and metastatic disease, MR imaging has enormous potential to help triage patients to appropriate treatment groups and provide imaging surveillance after therapy. This article reviews the MR imaging technique and the imaging characteristics of malignant disease of the uterine corpus and cervix.
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Affiliation(s)
- Michèle A Brown
- Department of Radiology, University of California, San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8756, USA.
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N'Kanza AL, Jobanputra S, Farmer P, Lovecchio J, Yelon JA, Rudloff U. Central nervous system involvement from malignant mixed Müllerian tumor (MMMT) of the uterus. Arch Gynecol Obstet 2005; 273:63-8. [PMID: 16010557 DOI: 10.1007/s00404-005-0004-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Accepted: 02/21/2005] [Indexed: 10/25/2022]
Abstract
The central nervous system is traditionally considered as an uncommon site for metastatic disease from the female genital tract, and cerebral metastasis as the primary manifestation of an occult gynecological malignancy is even more rare. Here, we report the case of a 61-year-old female who presented with neurological symptoms of confusion, headache, cerebellar ataxia and right-sided weakness. Magnetic resonance imaging of the brain revealed two solid lesions in the frontal lobe and the left cerebellar hemisphere. Endometrial biopsy of a uterine mass detected during search for the primary lesion showed malignant mixed Müllerian tumor (MMMT). The patient refused surgery. Cranial radiotherapy for progressive cerebral disease led to resolution of her neurological symptoms. Two months after the diagnosis of MMMT the patient died from local complications of advanced pelvic disease. At autopsy, only the epithelial component of the tumor had metastasized to the brain. Attention should be paid to possibility of unusual distant metastases associated to MMMT in order to avoid delay in diagnosis and treatment of these patients.
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Affiliation(s)
- Anne Lihau N'Kanza
- Department of Surgery, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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Park HM, Park MH, Kim YJ, Chun SH, Ahn JJ, Kim CI, Sung SH, Han WS, Kim SC. Mullerian adenosarcoma with sarcomatous overgrowth of the cervix presenting as cervical polyp: a case report and review of the literature. Int J Gynecol Cancer 2004; 14:1024-9. [PMID: 15361219 DOI: 10.1111/j.1048-891x.2004.014546.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- H M Park
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Women's University and Medical Research Center, Seoul 158-710, South Korea
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