Adenosarcoma of the uterus

From Libre Pathology
Jump to navigation Jump to search

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

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

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.
Retrieved from "https://librepathology.org/w/index.php?title=Adenosarcoma_of_the_uterus&oldid=39904"