The diagnosis and treatment of Mullerian adenosarcoma of the uterus

Abstract

Background: Adenosarcoma of the uterus is one of the rare types of gynaecological malignant tumours. Poor awareness of it among clinicians makes it difficult to diagnose correctly and timely, so it is helpful to enrich and update our knowledge about the tumour with new information of patients.

Aim: To improve the level of diagnosis and treatment of Mullerian adenosarcoma of the uterus.

Methods: The medical data of nine patients with Mullerian adenosarcoma of the uterus who were treated from May 1995 to March 2006 in our hospital were analysed retrospectively. The analysis focused on clinicopathological features, treatment and prognosis.

Results: Patients typically presented with abnormal uterine bleeding, pain in the lower abdomen, enlargement of the uterus, a mass in the uterine cavity and/or a cervical neoplasm. Microscopically, the glands were lined by benign or atypical glandular epithelium, together with sarcomatous stromal cells which showed characteristic structures of 'periglandular cuff' of increased cellularity and 'intraglandular polypoid projections'. The primary diagnostic rate was 33.3% and the average interval from symptom onset to final diagnosis was 13 months and eight weeks for pre- and postmenopausal patients, respectively. The prognosis was better in early stage disease in young patients.

Conclusions: The most common symptom of adenosarcoma of the uterus is abnormal uterine bleeding. Younger patients are more often misdiagnosed. Clinical stage and age of the patient are closely related to prognosis. Surgery is the primary treatment, and chemotherapy may be somewhat beneficial.