Difference between revisions of "Adenosarcoma of the uterus"

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#redirect [[Uterine_tumours#Adenosarcoma_of_the_uterus]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Uterine_adenosarcoma_-_high_mag.jpg
| Width      =
| Caption    = Uterine adenosarcoma. [[H&E stain]].
| Synonyms  =
| Micro      = "Malignant stroma" (stromal with nuclear pleomorphism - typically low grade), benign glands with an abnormal shape and "cambium layer" (increased cellularity around the epithelial elements)
| Subtypes  =
| LMDDx      = [[benign endometrial polyp]], [[uterine adenofibroma]], [[endometrial stromal sarcoma]]
| Stains    =
| IHC        = CD10 +ve, ER +ve, PR +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[uterus]] - see ''[[uterine tumours]]''
| Assdx      =
| Syndromes  =
| Clinicalhx = large age range
| Signs      = vaginal bleeding, mass lesion
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = other causes of [[AUB]]
| Tx        = TAH-BSO
}}
'''Adenosarcoma of the uterus''' is an uncommon tumour that arises from the [[uterus]] with benign glands and [[malignant]] mesenchymal elements.
 
==General==
Features:<ref name=pmid20179434>{{Cite journal  | last1 = McCluggage | first1 = WG. | title = Mullerian adenosarcoma of the female genital tract. | journal = Adv Anat Pathol | volume = 17 | issue = 2 | pages = 122-9 | month = Mar | year = 2010 | doi = 10.1097/PAP.0b013e3181cfe732 | PMID = 20179434 }}</ref>
*Uncommon.
*May prolapse through cervical os and thus present as [[cervical polyp]].
*Most commonly uterine corpus, occasionally cervix and ovary, rarely in the vagina, fallopian tube, peritoneal surfaces, intestine.
*Large age range<ref name=pmid9625851/> - may be premenopausal ''or'' postmenopausal.
 
Clinical:<ref name=pmid17506376>{{Cite journal  | last1 = Abu | first1 = J. | last2 = Ireland | first2 = D. | last3 = Brown | first3 = L. | title = Adenosarcoma of an endometrial polyp in a 27-year-old nulligravida: a case report. | journal = J Reprod Med | volume = 52 | issue = 4 | pages = 326-8 | month = Apr | year = 2007 | doi =  | PMID = 17506376 }}</ref>
*Most common presentations of Müllerian adenosarcoma (percentages based on series of 41 individuals<ref name=pmid9625851>{{Cite journal  | last1 = Verschraegen | first1 = CF. | last2 = Vasuratna | first2 = A. | last3 = Edwards | first3 = C. | last4 = Freedman | first4 = R. | last5 = Kudelka | first5 = AP. | last6 = Tornos | first6 = C. | last7 = Kavanagh | first7 = JJ. | title = Clinicopathologic analysis of mullerian adenosarcoma: the M.D. Anderson Cancer Center experience. | journal = Oncol Rep | volume = 5 | issue = 4 | pages = 939-44 | month =  | year =  | doi =  | PMID = 9625851 }}</ref>):
**Vaginal bleeding ~ 70%.
**Pelvic mass ~ 40%.
**Uterine polyp ~ 30%.
*Prognosis (based on series of ~500 individuals<ref name=pmid20688363>{{Cite journal  | last1 = Arend | first1 = R. | last2 = Bagaria | first2 = M. | last3 = Lewin | first3 = SN. | last4 = Sun | first4 = X. | last5 = Deutsch | first5 = I. | last6 = Burke | first6 = WM. | last7 = Herzog | first7 = TJ. | last8 = Wright | first8 = JD. | title = Long-term outcome and natural history of uterine adenosarcomas. | journal = Gynecol Oncol | volume = 119 | issue = 2 | pages = 305-8 | month = Nov | year = 2010 | doi = 10.1016/j.ygyno.2010.07.001 | PMID = 20688363 }}</ref>):
**Favourable outcome - most detected at an early stage.
***~80% five year survival for stage I tumours.
**Outcome better than [[uterine carcinosarcoma|carcinosarcoma]].
 
Treatment:
*TAH-BSO.
**Tumours are estrogen responsive.
*Chemotherapy (platin-based).<ref name=pmid9625851/>
 
==Microscopic==
Features:<ref name=Ref_PBoD1089>{{Ref PBoD|1089}}</ref><ref name=pmid20179434/>
*"Malignant stroma" - '''key feature'''.
**Stromal nuclear pleomorphism - usually low grade.
**WHO criteria: 2+ mitoses / 10 HPF -- definition suffers from [[HPFitis]].
***Mitotic rate criteria often ignored as mitotically inactive tumours metastasize.<ref name=pmid20179434/>
*Benign glands with an abnormal shape.
*"Cambium layer" = increased cellularity around the epithelial elements.<ref name=pmid20179434/><ref name=medilexicon_cambium/>
 
Notes:
*Tumour may vaguely resemble a [[phyllodes tumour]].<ref name=pmid20179434/>
*''Cambium layer'' - seen in: adenosarcoma, botryoid [[RMS]].<ref name=medilexicon_cambium>URL: [http://www.medilexicon.com/medicaldictionary.php?t=48297 http://www.medilexicon.com/medicaldictionary.php?t=48297]. Accessed on: 9 August 2011.</ref>
 
DDx:
*[[Benign endometrial polyp]].
*[[Uterine adenofibroma]].
*[[Endometrial stromal sarcoma]].
 
===Images===
<gallery>
Image:Uterine_adenosarcoma_-_low_mag.jpg | Uterine adenosarcoma - low mag. (WC)
Image:Uterine_adenosarcoma_-_intermed_mag.jpg | Uterine adenosarcoma - intermed. mag. (WC)
Image:Uterine_adenosarcoma_-_high_mag.jpg | Uterine adenosarcoma - high mag. (WC)
</gallery>
 
==IHC==
*CD10 +ve.<ref name=pmid20179434/>
*ER +ve.
*PR +ve.
 
==See also==
*[[Uterine tumours]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Gynecologic pathology]]

Latest revision as of 19:16, 21 September 2015

Adenosarcoma of the uterus
Diagnosis in short

Uterine adenosarcoma. H&E stain.
LM "Malignant stroma" (stromal with nuclear pleomorphism - typically low grade), benign glands with an abnormal shape and "cambium layer" (increased cellularity around the epithelial elements)
LM DDx benign endometrial polyp, uterine adenofibroma, endometrial stromal sarcoma
IHC CD10 +ve, ER +ve, PR +ve
Site uterus - see uterine tumours
Clinical history large age range
Signs vaginal bleeding, mass lesion
Prevalence uncommon
Clin. DDx other causes of AUB
Treatment TAH-BSO

Adenosarcoma of the uterus is an uncommon tumour that arises from the uterus with benign glands and malignant mesenchymal elements.

General

Features:[1]

  • Uncommon.
  • May prolapse through cervical os and thus present as cervical polyp.
  • Most commonly uterine corpus, occasionally cervix and ovary, rarely in the vagina, fallopian tube, peritoneal surfaces, intestine.
  • Large age range[2] - may be premenopausal or postmenopausal.

Clinical:[3]

  • Most common presentations of Müllerian adenosarcoma (percentages based on series of 41 individuals[2]):
    • Vaginal bleeding ~ 70%.
    • Pelvic mass ~ 40%.
    • Uterine polyp ~ 30%.
  • Prognosis (based on series of ~500 individuals[4]):
    • Favourable outcome - most detected at an early stage.
      • ~80% five year survival for stage I tumours.
    • Outcome better than carcinosarcoma.

Treatment:

  • TAH-BSO.
    • Tumours are estrogen responsive.
  • Chemotherapy (platin-based).[2]

Microscopic

Features:[5][1]

  • "Malignant stroma" - key feature.
    • Stromal nuclear pleomorphism - usually low grade.
    • WHO criteria: 2+ mitoses / 10 HPF -- definition suffers from HPFitis.
      • Mitotic rate criteria often ignored as mitotically inactive tumours metastasize.[1]
  • Benign glands with an abnormal shape.
  • "Cambium layer" = increased cellularity around the epithelial elements.[1][6]

Notes:

DDx:

Images

  • Uterine adenosarcoma - low mag. (WC)

  • Uterine adenosarcoma - intermed. mag. (WC)

  • Uterine adenosarcoma - high mag. (WC)

IHC

  • CD10 +ve.[1]
  • ER +ve.
  • PR +ve.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 McCluggage, WG. (Mar 2010). "Mullerian adenosarcoma of the female genital tract.". Adv Anat Pathol 17 (2): 122-9. doi:10.1097/PAP.0b013e3181cfe732. PMID 20179434.
  2. ↑ 2.0 2.1 2.2 Verschraegen, CF.; Vasuratna, A.; Edwards, C.; Freedman, R.; Kudelka, AP.; Tornos, C.; Kavanagh, JJ.. "Clinicopathologic analysis of mullerian adenosarcoma: the M.D. Anderson Cancer Center experience.". Oncol Rep 5 (4): 939-44. PMID 9625851.
  3. ↑ Abu, J.; Ireland, D.; Brown, L. (Apr 2007). "Adenosarcoma of an endometrial polyp in a 27-year-old nulligravida: a case report.". J Reprod Med 52 (4): 326-8. PMID 17506376.
  4. ↑ Arend, R.; Bagaria, M.; Lewin, SN.; Sun, X.; Deutsch, I.; Burke, WM.; Herzog, TJ.; Wright, JD. (Nov 2010). "Long-term outcome and natural history of uterine adenosarcomas.". Gynecol Oncol 119 (2): 305-8. doi:10.1016/j.ygyno.2010.07.001. PMID 20688363.
  5. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1089. ISBN 0-7216-0187-1.
  6. ↑ 6.0 6.1 URL: http://www.medilexicon.com/medicaldictionary.php?t=48297. Accessed on: 9 August 2011.
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