Müllerian Adenosarcomas With Unusual Growth Patterns

Blaise Alexander Clarke, Blaise Clarke, Anna Marie Mulligan, Julie A Irving, Irving JA, Julie Irving, W. Glenn McCluggage, McCluggage WG, Oliva E, Esther Oliva
International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists · 2011 · vol. 30(4) , pp. 340–347 · doi:10.1097/pgp.0b013e31820b341e · PMID:21623203 · W2029394313
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This report details three uterine adenosarcomas with rare growth patterns, including endometrial/adenomyosis involvement, origin in an adenomyoma, and synchronous endometrial/extrauterine tumors, proposing a descriptive reporting strategy and nomenclature for standardization.

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This paper examines three rare cases of uterine Müllerian adenosarcomas exhibiting unusual growth patterns that do not fit existing staging guidelines. The reported cases include tumors arising in eutopic endometrium with underlying adenomyosis, lesions originating within a mural adenomyoma, and synchronous extrauterine neoplasms. Because current classification systems lack specific criteria for these scenarios, the authors propose a descriptive reporting strategy and standardized nomenclature to facilitate future data collection. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Uterine adenosarcomas are uncommon mixed Müllerian neoplasms, most commonly arising in the uterine corpus. A new Federation of International Gynecologic Organization staging system for these tumors has recently been implemented. This staging system is an improvement on the earlier generic application of the 1988 Federation of International Gynecologic Organization staging system for endometrial cancer to adenosarcoma. Herein, we report 3 uterine adenosarcomas with unusual features. For 2 of these, no specific staging guidelines are provided by either the earlier or, more importantly, the new staging system. The first case is of an adenosarcoma arising in the eutopic endometrium with involvement of underlying adenomyosis without myometrial invasion; the second originated in a mural adenomyoma in the absence of eutopic endometrial involvement; and the third case encompassed synchronous endometrial and extrauterine (peritoneal) neoplasms. Such cases are rare, and there is insufficient evidence to be definitive about staging. Thus, we suggest a descriptive reporting strategy for adenosarcomas with these unusual features. We also propose a reporting nomenclature for such cases to ensure standardization such that they can be adequately recorded in synoptic reporting protocols. This will facilitate reliable data collection such that an evidence-based staging system for these scenarios may be derived.
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Müllerian Adenosarcomas With Unusual Growth Patterns Staging Issues - Blaise Alexander Clarke - Anna Marie Mulligan - Julie A. Irving - W. Glenn McCluggage - Esther Oliva Uterine adenosarcomas are uncommon mixed Müllerian neoplasms, most commonly arising in the uterine corpus. A new Federation of International Gynecologic Organization staging system for these tumors has recently been implemented. This staging system is an improvement on the earlier generic application of the 1988 Federation of International Gynecologic Organization staging system for endometrial cancer to adenosarcoma. Herein, we report 3 uterine adenosarcomas with unusual features. For 2 of these, no specific staging guidelines are provided by either the earlier or, more importantly, the new staging system. The first case is of an adenosarcoma arising in the eutopic endometrium with involvement of underlying adenomyosis without myometrial invasion; the second originated in a mural adenomyoma in the absence of eutopic endometrial involvement; and the third case encompassed synchronous endometrial and extrauterine (peritoneal) neoplasms. Such cases are rare, and there is insufficient evidence to be definitive about staging. Thus, we suggest a descriptive reporting strategy for adenosarcomas with these unusual features. We also propose a reporting nomenclature for such cases to ensure standardization such that they can be adequately recorded in synoptic reporting protocols. This will facilitate reliable data collection such that an evidence-based staging system for these scenarios may be derived.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenosarcoma Neoplasm Staging Neoplasm Staging Uterine Neoplasms Adenosarcoma Adenosarcoma Adult Endometrial Neoplasms Endometrial Neoplasms Endometriosis Endometriosis Fallopian Tubes Fallopian Tubes Fallopian Tubes Female Humans Hysterectomy International Cooperation Lymph Nodes Lymph Nodes

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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