The diagnosis and treatment of Mullerian adenosarcoma of the uterus

Shi, Yangyang; Liu, Zhiqiang; Peng, Zhilan; Liu, Hui; Yang, Kaixuan; Yao, Xian-ying

doi:10.1111/j.1479-828x.2008.00914.x

Cited by 21 publications

(9 citation statements)

References 12 publications

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“…8,9 Adenosarcoma is the second most-common malignancy to arise from extraovarian endometriosis after clear-cell carcinoma. 10,11 Risk factors for malignant transformation include pelvic irradiation and prolonged estrogen exposure, such as with combined oral contraceptive, hormonereplacement therapy, or tamoxifen use. 5,12 The clinical presentation of an extrauterine Müllerian adenosarcoma is variable and reflects the wide range of locations it can affect.…”

Section: Discussionmentioning

confidence: 99%

“…Fertility-sparing surgery may be an option when there is early disease with no evidence of sarcomatous overgrowth, but radical surgery with adjuvant chemotherapy or radiotherapy is otherwise recommended. 6,10,11 Conventionally, surgery is performed via laparotomy, although laparoscopic treatment of vaginal adenosarcoma was described by Pontrelli and colleagues in 2016. 5 In addition to the attendant benefits of minimally invasive surgery, this approach also allowed better visualization of the patient's anatomy with more accurate and complete resection.…”

Section: Discussionmentioning

confidence: 99%

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Two Cases of Extrauterine Müllerian Adenosarcoma Arising from Pelvic Endometriosis

Yuan

Ching

Kuei

et al. 2019

Journal of Gynecologic Surgery

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Background: Adenosarcoma arises most commonly in the uterus. Rarely, it may arise from extrauterine sites, such as the pelvic peritoneum and rectovaginal septum. Two cases of extrauterine Müllerian adenosarcoma arising from pelvic endometriosis are discussed. Cases and Results: Case 1: A 63-year-old woman presented with vaginal bleeding and a rectovaginal nodule. She underwent an extended hysterectomy with resection of a rectovaginal mass. Histology revealed endometriotic tissue. She returned 21 months later with abdominal distension, and underwent resection of large pelvic abdominal masses. Histology showed an adenosarcoma with sarcomatous overgrowth. Her disease progressed despite chemotherapy, and she died 5 months later. Case 2: A 70-year-old woman with previous breast cancer presented with urinary retention. Computed tomography showed a 13-cm pelvic mass. She underwent total abdominal hysterectomy and salpingo-oophorectomy. Intraoperatively, dense pelvic endometriosis was seen. Histology showed a stage 1C borderline endometrioid adenofibromatous tumor. She also underwent resection of a 10-cm incidentally discovered pelvic mass 18 months later. Histology showed a low-grade adenosarcoma arising from pelvic endometriosis. She was started on letrozole, and remained well postoperatively. Conclusions: Compared to uterine adenosarcoma, an extrauterine location confers a higher mortality and recurrence risk. Higher stromal grade or sarcomatous overgrowth worsen the prognosis, whereas an association with endometriosis is protective. The mainstay of treatment is surgery. Some surgeons recommend fertilitysparing surgery when there is no sarcomatous overgrowth, while others advocate radical surgery with adjuvant chemotherapy or radiotherapy. Further research is needed to define screening, treatment, and follow-up better. Clinicians should consider this rare diagnosis in any woman presenting with a pelvic mass with a history of endometriosis. (J GYNECOL SURG 35:194

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Two Cases of Extrauterine Müllerian Adenosarcoma Arising from Pelvic Endometriosis

Yuan

Ching

Kuei

et al. 2019

Journal of Gynecologic Surgery

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“…Three to six cycles with doxorubicin, dacarbazine, and vincristine was suggested for adjuvant chemotherapy for uterine adenosarcoma but the data are limited to determine efficacy [13]. Platinum based monotherapy or combination chemotherapy with platinum plus paclitaxel or ifosphamide was reported for ovarian MMMT [1,14].…”

Section: Discussionmentioning

confidence: 99%

Synchronous occurrence of primary malignant mixed müllerian tumor in ovary and uterus

Lee

Choi

et al. 2013

Obstet Gynecol Sci

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“…Shi et al [2] (2008) recommended a surgical approach similar to that used for the corresponding disease stages of endometrial carcinoma. Total abdominal hysterectomy with bilateral adnexectomy appears adequate for stage-I patients.…”

Section: Discussionmentioning

confidence: 99%

“…Adenosarcomas are rare tumors scarcely reported in the medical literature that associate benign glandular epithelium with a malignant endometrial stromal component of usually low histological grade. Occasionally, a high-grade malignant stromal component may raise a differential diagnosis issue with leiomyosarcomas and carcinosarcomas [1,2]. …”

Section: Introductionmentioning

confidence: 99%

Extragenital Müllerian adenosarcoma with pouch of Douglas location

et al. 2011

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BackgroundOf all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Müllerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature.Case PresentationA 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Müllerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy.ConclusionsThe case of Müllerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst.

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The diagnosis and treatment of Mullerian adenosarcoma of the uterus

Abstract: The most common symptom of adenosarcoma of the uterus is abnormal uterine bleeding. Younger patients are more often misdiagnosed. Clinical stage and age of the patient are closely related to prognosis. Surgery is the primary treatment, and chemotherapy may be somewhat beneficial.

Cited by 21 publications

References 12 publications

Two Cases of Extrauterine Müllerian Adenosarcoma Arising from Pelvic Endometriosis

Two Cases of Extrauterine Müllerian Adenosarcoma Arising from Pelvic Endometriosis

Synchronous occurrence of primary malignant mixed müllerian tumor in ovary and uterus

Extragenital Müllerian adenosarcoma with pouch of Douglas location

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