Extraendometrial mullerian adenosarcoma

An unusual case of mullerian adenocarcinoma involving multiple sites--the cervix, pelvic peritoneum, and ovary--without involvement of the endometrium is reported. This 38-year-old presented with vaginal bleeding and polypoid masses from the cervix. On two occasions, cervical punch biopsies were interpreted as endometriosis. Laparotomy revealed masses in the vesico-uterine space and in the cul-de-sac. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Microscopic examination showed benign glandular and malignant stromal elements in the specimen from the cervix, left ovary, vesico-uterine and cul-de-sac masses and intestinal implant. Postoperatively, she was treated with radiotherapy. Pelvic and vaginal recurrences were noted 4 months postoperatively. Presently, 12 months postoperatively, the patient is still undergoing chemotherapy with vincristine, doxorubicin, and cyclophosphamide. The clinical features, possible origin, problems of diagnosis and management, prognostic factors and recurrence patterns of this unusually located tumor are discussed.