Mullerian adenosarcoma of the uterus: A clinicopathologic analysis of 100 cases with a review of the literature

Clement, Philip B.; Scully, Robert E.

doi:10.1016/0046-8177(90)90198-e

Cited by 419 publications

(449 citation statements)

References 52 publications

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“…These rare neoplasms have a benign epithelial component, whereas the stromal component typically is of low grade. In 56% of the cases, the sarcomatous component was ESS alone and in an additional 9% of cases a mixture of ESS and fibrosarcoma was present (Clement and Scully, 1990). In uterine adenosarcoma lacking sarcomatous overgrowth, we documented that in 18 out of 20 (90%) of the cases either the oestrogen or the progesterone receptor stained positive in the sarcomatous component (Amant et al, 2004b).…”

Section: Discussionmentioning

confidence: 70%

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

et al. 2007

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The objective of this study is to assess the therapeutic importance of surgical castration, adjuvant hormonal treatment and lymphadenectomy in endometrial stromal sarcoma (ESS). A retrospective and multicentric search was performed. Clinicopathologic data were retrieved from cases that were confirmed to be ESS after central pathology review. The protocol was approved by the Ethical Committee. ESS was confirmed histopathologically in 34 women, but follow-up data were available in only 31 women. Surgical treatment (n ¼ 31) included hysterectomy with or without bilateral salpingo-oophorectomy (BSO) in 23 out of 31 (74%) and 8 out of 31 (26%) cases, respectively. Debulking surgery was performed in 6 out of 31 cases (19%). Stage distribution was as follows: 22 stage I, 4 stage III and 5 stage IV. Women with stage I disease recurred in 4 out of 22 (18%) cases. Among stage I women undergoing hormonal treatment with or without BSO, 3 out of 15 (20%) and 1 out of 7 (14%) relapsed, respectively. Among stages III -IV women receiving adjuvant hormonal treatment or not, 1 out of 5 (20%) and 3 out of 4 (75%) relapsed, respectively (differences ¼ 55.0%, 95% CI ¼ À6.8 -81.2%). Kaplan -Meier curves show comparable recurrence rates for stage I disease without adjuvant hormonal treatment when compared to stages III -IV disease treated with surgery and adjuvant hormonal treatment. Furthermore, women taking hormones at diagnosis have a better outcome when compared to women not taking hormonal treatment. Three out of 31 (9%) patients had a systematic lymphadenectomy whereas 3 out of 31 (9%) had a lymph node sampling. In one case, obvious nodal disease was encountered at presentation. Isolated retroperitoneal recurrence occurred in 1 out of 31 (3%) of all cases and in 1 out of 8 (13%) recurrences. This single woman later also developed lung and abdominal metastases. Leaving lymph nodes in situ does not appear to alter the clinical outcome of ESS. Although numbers are low, the retrospective data suggest that the need for surgical castration (BSO) in premenopausal women with early-stage disease should be discussed with the patient on an individual basis. The data support the current practice in some centres to administer adjuvant hormonal treatment.

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Section: Discussionmentioning

confidence: 70%

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

et al. 2007

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“…The uterine corpus is the most common location in the female genital tract, but these neoplasms also arise in the cervix, ovary or vagina, or more rarely in the peritoneum. [34][35][36][37] …”

Section: Mullerian Adenosarcomamentioning

confidence: 99%

A practical approach to the diagnosis of mixed epithelial and mesenchymal tumours of the uterus

McCluggage

2016

Modern Pathology

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The current 2014 World Health Organization (WHO) Classification of mixed epithelial and mesenchymal tumours of the uterus includes categories of carcinosarcoma, adenosarcoma, adenofibroma, adenomyoma and atypical polypoid adenomyoma, the last two lesions being composed of an admixture of benign epithelial and mesenchymal elements with a prominent smooth muscle component. In this review, each of these categories of uterine neoplasm is covered with an emphasis on practical tips for the surgical pathologist and new developments. In particular, helpful clues in the distinction between carcinosarcoma and dedifferentiated endometrial carcinoma will be discussed. In addition, salient features to help distinguish between adenofibroma, adenosarcoma, embryonal rhabdomyosarcoma and other mesenchymal neoplasms in the differential diagnosis will be outlined. Finally, a discussion of adenomyoma and its main differential diagnostic considerations will be covered.

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“…4,[6][7][8] Adenosarcomas less frequently occur in the ovary, where they pose a greater risk of peritoneal spread and a worse prognosis. 8 The mainstay of treatment for localized Müllerian adenosarcomas is surgery, 9 whereas more advanced diseases often entail other modalities of treatment, although the roles of adjuvant chemotherapy and/or radiation therapy in the management of adenosarcomas are not well-defined. The previous lack of knowledge regarding the molecular and genetic basis of Müllerian adenosarcomas has hindered our ability to develop tumor-specific therapeutic strategies.…”

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confidence: 99%

Genomewide copy number analysis of Müllerian adenosarcoma identified chromosomal instability in the aggressive subgroup

Lee

Changou

et al. 2016

Modern Pathology

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Müllerian adenosarcomas are malignant gynecologic neoplasms. Advanced staging and sarcomatous overgrowth predict poor prognosis. Because the genomic landscape remains poorly understood, we conducted this study to characterize the genomewide copy number variations in adenosarcomas. Sixteen tumors, including eight with and eight without sarcomatous overgrowth, were subjected to a molecular inversion probe array analysis. Copy number variations, particularly losses, were significantly higher in cases with sarcomatous overgrowth. Frequent gains of chromosomal 12q were noted, often involving cancer-associated genes CDK4 (six cases), MDM2, CPM, YEATS4, DDIT3, GLI1 (five each), HMGA2 and STAT6 (four), without association with sarcomatous overgrowth status. The most frequent losses involved chromosomes 13q (five cases), 9p, 16q and 17q (four cases each) and were almost limited to cases with sarcomatous overgrowth. MDM2 and CDK4 amplification, as well as losses of RB1 (observed in two cases) and CDKN2A/B (one case), was verified by FISH. By immunohistochemistry, all MDM2/CDK4-coamplified cases were confirmed to overexpress both encoded proteins, whereas all four cases with (plus an additional four without) gain of HMGA2 overexpressed the HMGA2 protein. Both cases with RB1 loss were negative for the immunostaining of the encoded protein. Chromothripsis-like copy number profiles involving chromosome 12 or 14 were observed in three fatal cases, all of which harbored sarcomatous overgrowth. With whole chromosome painting and deconvolution fluorescent microscopy, dividing tumor cells in all three cases were shown to have scattered extrachromosomal materials derived from chromosomes involved by chromothripsis, suggesting that this phenomenon may serve as visual evidence for chromothripsis in paraffin

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Mullerian adenosarcoma of the uterus: A clinicopathologic analysis of 100 cases with a review of the literature

Cited by 419 publications

References 52 publications

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

A practical approach to the diagnosis of mixed epithelial and mesenchymal tumours of the uterus

Genomewide copy number analysis of Müllerian adenosarcoma identified chromosomal instability in the aggressive subgroup

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