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Cervical and uterine cancers
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Rosemarie Forstner, Andrea Rockall
Adenosarcoma is a rare subtype of sarcoma composed of mixed benign epithelial and malignant mesenchymal components. They present low-grade tumours with slow growth and a favourable prognosis of an 80% 5-year-survival rate (252). Adenosarcomas arise within the endometrial cavity or the endocervical canal. The majority are diagnosed at stage I (231). Lymph node and distant metastases are rare even in the recurrence setting. The recurrence rate ranges from 25% to 33% at 5 years and is typically found in the vagina or cervix (231).
Benign tumors and tumor-like conditions, including metaplasia
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
The following conditions may sometimes be confused with an endometrial polyp, especially in endometrial aspirates with limited material. Basalis layer of endometrium could have thick-walled vessels within cellular spindly stroma, but the glands are generally tubular and inactive or weakly proliferative, and polypoid fragments are not seen.Isthmic endometrium in the lower uterine segment usually shows relatively fibrous stroma and few glands, but the absence of thick-walled vessels and admixture of endocervical mucinous epithelium and ciliated epithelium may aid distinction from an endometrial polyp.14Adenomyomatous polyp (or uterine adenomyoma) is distinguished from endometrial polyp by the presence of predominating smooth-muscle stroma.Adenosarcoma (or Müllerian adenosarcoma) may be distinguished from endometrial polyp by its size (usually >3 cm), typically well-developed and diffuse phyllodes-like architecture and the presence of stromal cell atypia (often diffuse, with coarse chromatin, nuclear enlargement and irregular nuclear membranes).7 For endometrial polyps, the size is usually <3 cm, phyllodes-like architecture may be present but is usually poorly developed or focal, while stromal cell atypia is rare and usually focal and mild.7
MRI findings characteristic of ovarian primary adenosarcoma
Published in Journal of Obstetrics and Gynaecology, 2020
Tatsuro Horiuchi, Tsukuru Amano, Ayumi Seko-Nitta, Akimasa Takahashi, Fuminori Kimura, Takashi Murakami
The macroscopic findings of the tumour are as shown in the Figure 1(C). The polyp surface was smooth and the split surface had a uniform white colour. Histopathologic findings of the tumour, in addition to the findings of endometriosis, showed poorly heterozygous epithelia invading into the interstitium in the polypoid-rich portion, along with a cleft-like glandular structure, and the protruded component showed a leaf-like pattern. In addition, the interstitial spindle-shaped cells showed high periglandular cuffing around the epithelium and gland. These findings were suggestive of an adenosarcoma (Figure 1(D)). The nuclear atypia of the stromal cells was mild, about 2/10 HPF at sites with high fission, and no excessive proliferation of sarcoma components was observed. Based on the strong desire of the patient for preservation of her fertility, she was followed up in the outpatient facility without additional treatment. Recurrence has not been reported for 34 months.
Preoperative diagnosis of atypical pelvic leiomyoma and sarcoma: the potential role of diffusion-weighted imaging
Published in Journal of Obstetrics and Gynaecology, 2019
Victoria Valdes-Devesa, Maria del Mar Jimenez, David Sanz-Rosa, Mercedes Espada Vaquero, Elena Alvarez Moreno, Ricardo Sainz de la Cuesta Abbad
Uterine sarcomas are rare myometrial tumours that account for 3–7% of uterine malignancies (D’Angelo and Prat 2010). Leiomyosarcoma and carcinosarcoma remain as the most common subtypes, followed by the endometrial stromal sarcoma, adenosarcoma and undifferentiated sarcomas. Their prognosis is poor, with a five-year survival rate of 30% (Tropé et al. 2012).
Prognostic factors for uterine adenosarcoma: a review
Published in Expert Review of Anticancer Therapy, 2018
Michael J. Nathenson, Anthony P. Conley
Uterine adenosarcoma is a very rare disease. Research regarding uterine adenosarcomas has been hindered by its rarity. The current standard of care is surgical resection alone. Hysterectomy is usually preformed with bilateral salpingo-oophorectomy. Lymphadenopathy is not necessary, unless there is clinical evidence lymph node involvement. Lymph node involvement is rare, reported in 0–6.5% of uterine adenosarcoma cases [8,13,15,16,21]. However, lymph node involvement does portend a worse prognosis [22]. So, lymphadenectomy can be considered in select patients. There is no defined role for neoadjuvant or adjuvant radiation or chemotherapy for uterine adenosarcomas. Some patients at low risk of recurrence will not need further therapy and can simply be observed. Unfortunately, there are additional patients with sarcomatous overgrowth, myometrial invasion, lymphovascular invasion, or lymph node involvement, that are at a significantly higher risk of recurrence and death from their disease. These patients need to be closely monitored for disease recurrence with CT scans of the chest abdomen and pelvis every three months. Current evidence-based treatment for these high-risk patients leaves a great deal to be desired. Ideally, these patients should receive adjuvant therapy to decrease their chance of recurrence and increase their chance of a cure. Radiation therapy can dramatically reduce the risk of local recurrence, but there is little evidence to suggest that this is the case for uterine adenosarcomas [5]. Systemic chemotherapy can be effective for uterine adenosarcoma in the metastatic setting; particularly Adriamycin-based chemotherapy and gemcitabine/docetaxel. The evidence of adjuvant chemotherapy for uterine adenosarcomas is limited to case report and case series [5]. Prognostic factors are key in determining uterine adenosarcoma patients at high risk of recurrence who may need additional therapy. Despite the limited clinical evidence, it is reasonable to consider adjuvant chemotherapy with Adriamycin and ifosfamide for uterine adenosarcoma patients with sarcomatous overgrowth, lymphovascular invasion, lymph node involvement, and/or myometrial invasion, as long as they have limited comorbidities that can tolerate this treatment [5]. Alternatively, enrolling these patients on clinical trials to determine the efficacy of adjuvant chemotherapy is also reasonable. These patients should be referred to tertiary care centers experienced in the treatment of this rare disease.