Clinicopathological analysis of mullerian adenosarcoma of the uterus

摘要

Uterine mullerian adenosarcoma is a very rare tumor clinically. Shi et al1 has reported 9 uterine adenosarcomas among 116 uterine sarcomas during 11 years in West China Second Hospital. It consists of benign or atypical neoplastic glands within a sarcomatous stroma and represents only 8% of uterine sarcomas. Its histological features are intermediate between the benign adenofibroma and the highly malignant carcinosarcoma and biologic behaviors show low malignant potential.2 In this report, we analyzed nine cases of uterine mullerian adenosarcoma, and the clinical characteristics, diagnosis, treatment and prognosis of this tumor were discussed. CLINICAL DATA Between January 2003 and February 2009, nine patients diagnosed as uterine mullerian adenosarcoma in surgical pathology files were treated in Peking Union Medical College Hospital. Of the nine cases, six were located in the endometrium and the remaining three were originated from cervix. This original research was approved by the local institutional review board. Clinical findings The patients ranged in age from 18 to 47 years (average 33.8 years, median 31 years). Six women were ≤40 years of age. Two patients were postmenopausal. The mean gravity and parity were 1.2 and 0.6 (range 0-4 and 0-2) respectively. Six women were nulligravida. The chief complaints of 6 uterine endometrial mullerian adenosarcomas were abnormal vaginal bleeding (5 cases); pelvic pain (3 cases) and abnormal vaginal discharge (one case). These tumors tended to appear as exophytic polypoid masses growing inside the uterine cavity and occasionally extended from the uterus via cervical orifice. Physical examinations showed enlarged uterus (3 cases), cervical neoplasm protruding from the external cervical os or palpable pelvic mass (2 cases, each) and vaginal mass (one case). The presenting manifestations of cervical adenosarcoma included irregular menstruation, repeating vaginal discharge and evacuation of tissues from vagina. Cervical polypoid neoplasms were the presenting sign in all the three patients with an enlarged uterus in one patient. The patients were staged according to FIGO staging criteria for endometrial cancer and cervical cancer. Of the six uterine endometrial adenosarcoma, there were one stage Ia, two stage Ib, one stage Ic and two stage III. Three cervical adenosarcoma patients were all stage I (Table).Table: Clinicopathological features of 9 cases of uterine mullerian adenosarcomaPrimary diagnosis and pathological findings Six patients were diagnosed correctly before surgery through histologic examinations of resected lesions or reviewing of pathological slides from other hospitals; two patients were interpreted as endometrial stromal tumors; and the other one was considered to be endometrioma- like polypus. The pathologic features were summarized in Table. On gross examination, maximum tumor size ranged from 1.0 to 12.0 cm (mean, 6.1 cm). Tumors exhibited polypoid, papillary or bulbous growth pattern and they had the appearance of grayish pink, grayish white or dark tan in color. The cutting surface was commonly solid and jelly-like cyst fluid was noted in two cases. Microscopically, the tumors were composed of benign or atypical-appearing neoplastic glands within a sarcomatous stroma which appeared as periglandular cuffs or intraglandular polypoid projections of increased cellular structure (Figure 1). The mitotic rate was 5-15 per 10 high-power fields. No muscular invasion was found in four patients and superficial muscular invasion in two patients; deep muscular invasion existed in two patients. Sarcomatous overgrowth in which a pure sarcomatous component occupied at least 25% of the tumor was present in three cases (Figure 2, Table). Heterologous elements which were striated muscle and chondrometaplasia were identified in two patients. Immunohistochemically, the stromal cells were negative with CD10 in four out of six cases. The other two cases were focally positive with CD10.Figu