Mullerian Adenosaroma of the Cervix with Sarcomatous Overgrowth and Heterologous Elements Presenting as a Recurrent Cervical Polyp

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.

Case Report of Successful Childbearing after Conservative Surgery for Cervical Mullerian Adenosarcoma

“…Clinical presentation of cervical MAs often resembles either a benign endocervical or endometrial polyp or a pedunculated submucosal leiomyoma protruding through a cervical canal. Cervical MAs are reported to occur in relatively younger women (mean age 27 years), while tumors originating from the uterine endometrium generally present in postmenopausal women (median age 58 years) [4, 6]. …”

Mullerian adenosarcoma of the cervix: case report

“…6,24 Mean age of cases reported worldwide has been 33±18 years. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]24 Extensive literature review shows that the most common modes of clinical presentation are irregular menstrual bleeding (41%), painless mass in the introitus (41%), postmenstrual bleeding (7%), urinary retention (7%) and postcoital bleeding and vagina discharge (3% each). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]24 Our patient presented with feeling of a mass in the introitus and irregular bleeding per vaginam.…”

“…The occurrence of heterologous differentiation, as seen in our case, has been about 69% and mostly as cartilage, bone and skeletal muscle. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Such heterologous elements, usually cartilaginous, as seen in this case, may also be seen in adenofibroma, carcinosarcoma and embryonal rhabdomyosarcoma (ERMS). Like ERMS MAs may show cambium-like disposition but phyllodes-like histology seen in MA is not present in ERMS.…”

“…Treatments given have included hysterectomy, with or without bilateral salpingo-oophorectomy, with or without pelvic lymph node clearance and with or without adjuvant chemo-and/ or radiotherapy. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] However, the underlying principle of management is to prevent recurrence and/or metastasis. In staging the disease it is our opinion that there may be need to carry out endometrial curettage, vaginal biopsy as well as exploratory laparotomy to exclude spread to other tissues because of their anatomical contiguity.…”

“…These tumours may affect any age group including children. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Mullerian adenosarcomas (MA) account for about 8% of all uterine sarcomas. 6 In Nigeria, even though Omoniyi-Esan et al 21 have reported 2 cases of pure sarcomas over a ten year period, our report, from available literature, is the first for MA in the country.…”