Gynecologic Cancer InterGroup (GCIG) Consensus Review for Mullerian Adenosarcoma of the Female Genital Tract

Friedlander, Michael; Covens, Alan; Glasspool, Rosalind; Hilpert, Felix; Kristensen, Gunnar B.; Kwon, Sang-Hoon; Selle, Frédèric; Small, William; Witteveen, Els O.; Russell, Peter

doi:10.1097/igc.0000000000000239

Cited by 50 publications

(55 citation statements)

References 29 publications

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“…The standard-of-care treatment for uterine adenosarcomas is surgical resection with hysterectomy and BSO. 1,2,5,28,29 Laparoscopic hysterectomy with morcellation is contraindicated in uterine sarcomas and should never be performed. Morcellation leads to seeding within the abdominal cavity and the development of sarcomatosis, resulting in poor clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Lymphovascular Invasion in Uterine Adenosarcomas: Analysis of Clinical, Prognostic, and Treatment Outcomes

Nathenson

Conley

Lin

et al. 2018

Int J Gynecol Cancer

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This study highlights the importance of LVI as a prognostic factor and confirms the prognostic significance of SO, MI, age, resection status, and FIGO stage for adenosarcoma. Furthermore, this study suggests that there is no additional benefit to adjuvant radiation. The standard-of-care treatment for adenosarcoma should remain total abdominal hysterectomy bilateral salpingo-oophorectomy +/- lymphadenectomy and no adjuvant radiation.

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Section: Discussionmentioning

confidence: 99%

The Importance of Lymphovascular Invasion in Uterine Adenosarcomas: Analysis of Clinical, Prognostic, and Treatment Outcomes

Nathenson

Conley

Lin

et al. 2018

Int J Gynecol Cancer

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“…The 2003 WHO book and the College of American Pathologists (CAP) defined SO as sarcoma, “usually high grade,” comprosing 25% or more of the total tumor volume. Histologically “low-grade SO” has also been reported (10,11,12). …”

Section: Discussionmentioning

confidence: 99%

The Impact on Survival of an Extensive Sex Cord-like Component in Mullerian Adenosarcomas

Stolnicu

Molnar

Bârsan

et al. 2016

International Journal of Gynecological Pathology

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Summary Mullerian adenosarcomas are uncommon tumors of the female genital tract characterized by a synchronous proliferation of benign glands and sarcomatous stroma. In general, uterine Mullerian adenosarcomas are associated with a low risk of recurrence. The presence of “stromal overgrowth” (SO), historically defined by an estimate of the volume of sarcoma growing independently of epithelium, is associated with deep myometrial invasion, presence of heterologous elements, and poor outcomes. Very rarely, the stromal component can harbor foci resembling ovarian sex cord tumors (FROSCT). The aim of this study was to determine whether the presence of an extensive FROSCT component in Mullerian adenosarcomas has an impact on survival, akin to more typical types of SO. Six patients were included in this study. Age ranged from 39-71 years. Five patients presented with uterine lesions (4 intracavitary, 1 isthmic), and one was located in the ovary. Tumors ranging in size from 2.5 to 19 cm were all diagnosed as stage I. Morphologically, all had prominent FROSCT-like components that comprised 60-90% of tumor volume. Immunohistochemically, the FROSCT component was positive for CAM 5.2, Vimentin, WT1, CD56, α-inhibin, calretinin, androgen and progestogen receptors, α-actin, and desmin. All patients are alive without disease at 26-102 months. Compared to adenosarcomas with typical forms of SO, FROSCT overgrowth is low grade and not associated with recurrence or metastasis in this small series. Therefore, Mullerian adenosarcoma with extensive FROSCT should not be equated with SO.

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“…Regarding the surgery of uterine adenosarcoma, in our institution, 46.8% of patients with uterine adenosarcoma underwent TH and BSO. TH and BSO have been recommended for the majority of patients with uterine adenosarcoma . However, BSO may not be necessary for premenopausal women; it is not associated with more survival benefits .…”

Section: Discussionmentioning

confidence: 99%

Uterine and Cervical Adenosarcoma: A Retrospective Study of Overall Oncologic Outcomes and Fertility Preservation in Early-Stage Disease

Yuan

Cao

et al. 2019

The Oncologist

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Background The management of adenosarcoma is based on the limited available data. This study aimed to explore the characteristics and oncologic outcomes of patients with uterine and cervical adenosarcoma. Materials and Methods A total of 21 and 32 cases of cervical and uterine adenosarcoma, respectively, were retrospectively reviewed in Peking Union Medical College Hospital between April 2006 and March 2019. Results The median follow‐up time was 37.5 months (range, 1–153 months). The disease progression rate (DPR) was significantly higher in patients with uterine adenosarcoma compared with those with cervical adenosarcoma (28.1% vs. 4.8%). The curve of progression‐free survival significantly differed. For those with cervical adenosarcoma, the presence of a tumor stalk was a protective factor, whereas heterologous elements (HE) presented a risk factor for disease progression. For those with uterine adenosarcoma, the presence of a tumor stalk was an independent protective factor, whereas lymphovascular space invasion (LVSI) was an independent risk factor for disease progression. Moreover, HE was an independent risk factor for mortality. Fertility‐sparing surgery (FSS) was performed in four and five patients with cervical and uterine adenosarcoma, respectively. Regarding FSS, combined with cases in previous studies, the DPR of patients with uterine adenosarcoma was relatively higher compared with those with cervical adenosarcoma. Conclusion We found that cervical adenosarcoma had a better prognosis than uterine adenosarcoma. The presence of a tumor stalk was a protective factor, whereas HE and LVSI were risk factors for prognosis. For those with uterine adenosarcoma, if FSS was administered, robust evaluation would be necessary. The small sample size limits the ability to make any strong conclusions about FSS. Implications for Practice Uterine cervical adenosarcoma had a better prognosis than uterine adenosarcoma. For patients with cervical adenosarcoma, the presence of a tumor stalk was a protective factor and the presence of heterologous elements (HE) was a risk factor for disease progression. For those with uterine adenosarcoma, the presence of a tumor stalk was a protective factor and lymphovascular space invasion was a risk factor for disease progression. Moreover, HE was a risk factor for mortality. Regarding fertility‐sparing surgery (FSS), the disease progression rate was higher in patients with uterine adenosarcoma compared with those with cervical adenosarcoma. For patients with uterine adenosarcoma, if FSS was administered, hysteroscopy and robust imaging evaluation would be necessary.

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Gynecologic Cancer InterGroup (GCIG) Consensus Review for Mullerian Adenosarcoma of the Female Genital Tract

Cited by 50 publications

References 29 publications

The Importance of Lymphovascular Invasion in Uterine Adenosarcomas: Analysis of Clinical, Prognostic, and Treatment Outcomes

The Importance of Lymphovascular Invasion in Uterine Adenosarcomas: Analysis of Clinical, Prognostic, and Treatment Outcomes

The Impact on Survival of an Extensive Sex Cord-like Component in Mullerian Adenosarcomas

Uterine and Cervical Adenosarcoma: A Retrospective Study of Overall Oncologic Outcomes and Fertility Preservation in Early-Stage Disease

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