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Adenosarcoma of the uterus (view source)
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'''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. | |||
*Typically 30-40 years old. | |||
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]]. | |||
===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]] | |||