Sarcopedia

MalignantSoft tissue

Adenosarcoma

Synonyms: Müllerian Adenosarcoma

Abnormal vaginal bleeding

Quick Facts

Behaviour

Malignant

Category

Soft tissue

Grade

Variable

Synonyms

Müllerian Adenosarcoma

Category

Soft tissue

Behaviour

Malignant

Grade

Variable

Gender

Female

Tissue of Origin

Müllerian-derived tissues (Endometrium, Ovary)

Epidemiology

  • Rare; 5% of uterine sarcomas
  • Peak incidence 6th–7th decades, but can occur in adolescents

Clinical Features

  • Abnormal vaginal bleeding
  • Pelvic pain
  • Polypoid mass protruding through the cervical os

Location

  • Uterine corpus (most common)
  • Cervix and ovaries
  • Extra-uterinely in pelvic soft tissue (associated with endometriosis)

Imaging

  • USS: thickened endometrium, large hterogenous mass
  • MRI: polypoid mass filling endometrial cavity with cystic components

Pathology

Benign epithelial-lined glands surrounded by hypercellular stroma

Genetics

Variable; no single pathognomonic translocation

Treatment

Total Hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). Adjuvant therapy (chemo/radiation) usually reserved for advanced stage

Prognosis

  • Excellent for low-grade tumors confined to the endometrium (5-year survival >90%)
  • Prognosis drops with sarcomatous overgrowth or deep myometrial invasion

Workup - Blood Tests

  • FBC, U&E, LFTs - preoperative baseline
  • Ca-125 - elevated in ovarian cases or advanced disease

Workup - Local Imaging

MRI with contrast of primary site

Workup - Biopsy

Endometrial biopsy

Workup - Staging

CT chest/abdomen/pelvis

Workup - Other

Evaluation for endometriosis

Follow-up Summary

  1. 1

    Speculum and bimanual pelvic examination and CXR or CT chest every 3–4 months for the first 2–3 years, then every 6 months to 5 years

  2. 2

    Annual CT Abdomen/Pelvis if high-grade features present

Medical disclaimer

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