Adenosarcoma of the Uterus: A Case Report

Şivekar Tinar, MD; Salim Şehirali, MD; M. Murat İnal, MD; Yusuf Yildrim, MD; Esin Çelik, MD; Seyran Yiğit, MD

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Discussion

Adenosarcoma is a rarely observed variant of mixed mullerian tumors,[1,2] consisting of neoplastic glands with benign appearance and a sarcomatous stroma. Kerner and Lictig[10] reported that an early sign of a uterine adenosarcoma is its protrusion as a prominent cervical polyp. This has been observed in 7 adenosarcoma cases in women between the ages of 14 and 63 years. These cases were diagnosed as cervical polyps formerly with the protrusion of the tumor from the external ostium. In our case, the mass also protruded from the cervical channel with a polypoid appearance.

Clement and colleagues[11] evaluated 100 women between the ages of 14 and 89 years with uterine adenosarcomas. Most of these cases had abnormal vaginal bleeding as a symptom, like our case. Pelvic examination in each of the cases revealed a large uterus and a polypoid mass protruding from the external ostium of the cervix. Recurrent polyps were observed in 5 cases. The general approach to management was to perform hysterectomy, although a more conservative approach (ie, conservative resection) was taken in 4 cases. Although adenosarcomas have less tendency to invade, 4 cases in this series were found to have metastasis, and a recurrent mass was observed in 23 cases. Recurrent metastasis generally involved the vagina, pelvis, and abdomen.[11] The postoperative interval to recurrence was 5 years in about a third of the cases.[11]

Katu and colleagues[12] proposeperforming a staging laparatomy for stage I and stage II adenosarcomas. For our case, we performed peritoneal washing for cytologic examination followed by a total abdominal hysterectomy, bilateral salphingo-oophorectomy, pelvic-para-aortic lymph node sampling, and a partial omentectomy. Guidozzi and Smith[13] have also evaluated the management and results of 3 cases of mullerian adenosarcoma with extrauterine metastasis. They performed type II radical abdominal hysterectomy, bilateral salpingho-oophorectomy, and omentectomy in all of the cases, as well as postoperative radiochemotherapy.

Hallak and colleagues[14] reported a case of a 25-year-old woman dignosed with adenosarcoma after endometrial sampling. This group performed total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic-para-aortic lymph node dissection. Fait and colleagues[15] also reported a single case who was managed with total abdominal hysterectomy, bilateral salpingho-oophorectomy, and pelvic lymph node sampling as well as with radiotherapy and chemotherapy (50 mg/m2 doxorubicine and 5 mg/m2 ifosfamide) in the postoperative period. During the follow-up, a disease-free interval of 46 months was reported. Ventura and colleagues[16] suggest a follow-up approach instead of chemotherapy and radiotherapy if no myometrial invasion is observed. Our case had no myometrial invasion. We decided to follow up our case because of the low stage of the disease after the radical operation was performed. At 14 months, no recurrence was observed.

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