Nonpuerperal uterine inversion caused by an adenosarcoma: A case report.

INTRODUCTION: Eighty-five per cent of uterine inversions are puerperal. Non-puerperal uterine inversion is usually caused by tumours that exert a traction force on the fundus of the uterus. This causes the uterus to be partially or completely inverted. It is commonly related to benign tumours like submucosal leiomyomas. Nevertheless, malignancies are an infrequent association. CASE PRESENTATION: We report a case of a 35-year-old female patient, medically and surgically free, gravida0 para0, complaining of menometrorrhagia associated with pelvic pain for 2 years. A suprapubic ultrasound scan showed an enlarged, globular uterus with a heterogeneous, undefined mass of 49 mm in size. MRI scan showed the appearance of a U-shaped uterine cavity and a thickened inverted uterine fundus with an endometrial infiltrating mass of 25 mm. Intraoperative exploration showed uterine inversion involving the ovaries; the fallopian tubes and the round ligaments and a necrotic intracavitary mass. The malignancy of the tumor was confirmed through anatomopathological examination as Adenosarcoma. CONCLUSIONS: Uterine inversion is rare outside the puerperal period, and malignant etiology must not be overlooked. Therefore, comprehensive care with meticulous etiological investigation is crucial.

Hemoperitoneum due to breaking uterine adenosarcoma located in the omentum. Report of a case.

AIM: We report an unusual case of broken adenosarcoma located in the omentum that has procured a clinical situation of acute abdomen in a patient. CASE REPORT: A 79 year-old woman went to the emergency room for growing abdominal pain and then transferred to our department. In previous years the patient had removed endo-cervical and endometrial fibro-glandular polyps and subsequently to a total laparoscopic hysterectomy with bilateral oophorectomy was performed for another endometrial fibroglandular polyp; other vaginal recurrences were then removed. We performed a computed tomography thanks to which we made a diagnosis of moderate hemoperitoneum. RESULTS: The patient underwent to a laparotomy. After abdominal blood removal was evidenced the presence of a damaged big cystic formation starting from the epiploon, containing blood and necrotic debris treated with omentectomy. The subsequent histopathological examination revealed that this tumor was an adenosarcoma. DISCUSSION: Rarely adenosarcoma can grow in extrauterine locations. The simptoms are related to the localization. Even during an emergency surgery it is important to respect the criteria of oncological radicality. You must avoid the tumor dissemination in order to reduce late recurrences, and to achieve a better final histologic diagnosis should avoid intraoperative extemporaneous histological examination. CONCLUSIONS: This case is an example of how many diagnostic pitfalls you can hide in emergency surgery, but in conclusion it remains a doubt about our experience: it is not possible to know if this tumor was a primary extra-uterine neoplasm or a recurrence of fibro-glandular polyps removed years before already in malignant transformation? KEY WORDS: Acute Abdomen, Adenosarcoma, Hemoperitoneum, Omentum.

Adenosarcoma of the uterine body initially presenting as an interstitial small tumor of the uterus: a case report.

Adenosarcoma of the uterine body is a rare mixed tumor in which a benign epithelial component is mixed with a malignant stromal element. It has been considered that this tumor originates from the endometrium and its most common finding of imaging is a polypoid tumor occupying the uterine cavity. The authors herein present a case of 37-year-old female with a complaint of abnormal vaginal bleeding. At the first visit, transvaginal ultrasound and magnetic resonance imaging (MRI) showed a round mass with a diameter of one cm in the uterine wall. No malignant pathological finding was detected. The patient visited the authors again one year later, because of continuous bleeding. At that time, they found a polypoid tumor in the uterine cavity, which turned out to be adenosarcoma with sarcomatous overgrowth. The round mass in the uterus detected at first time seems to have been incipience of adenosarcoma. Prodromal sign of adenosarcoma has not been reported previously.

Adenosarcoma mülleriano de útero: un tumor infrecuente de difícil diagnóstico / Uterine müllerian adenosarcoma: report of a case and review of the literature

El adenosarcoma de útero es una neoplasia rara y representa aproximadamente el 8% de todos los sarcomas uterinos. Está relacionado con antecedentes de tratamiento con tamoxifeno y con radiación pélvica. La clínica más característica es la de una lesión polipoide recidivante, siendo habitual que la paciente ya haya tenido algunas biopsias previas por ese mismo motivo, en las cuales no haya podido llegarse a un diagnóstico acertado y definitivo. Incluso puede haber llegado a darse un diagnóstico erróneo, de los cuales el más frecuente es el de un pólipo cervical. La lesión consta de un componente glandular benigno creciendo inmerso en un estroma sarcomatoso. Presentamos el caso de una mujer de 53 años con una lesión polipoide uterina. Tras los estudios macroscópico, microscópico e inmunohistoquímico se llegó al diagnóstico de adenosarcoma mülleriano de útero. Se trata de una neoplasia de bajo grado y buen pronóstico, pero que recidiva en un alto porcentaje de casos (25-40%). El tratamiento es la histerectomía total simple con doble anexectomía, seguida o no de radioterapia postoperatoria, aunque en pacientes jóvenes, que no tienen el deseo genésico cumplido, al ser una neoplasia de bajo grado, se han descrito casos en los que se ha optado por un tratamiento conservador. De todas formas, no hay que olvidar que se trata de un tumor maligno y que también se han descrito casos de fallecimiento por esta entidad a causa de metástasis abdominales o de otro tipo, por lo que somos de la opinión de que la mejor y más segura opción terapéutica es la histerectomía (AU)

Uterine adenosarcoma is a rare neoplasm constituting only around 8% of all uterine sarcomas. This tumor is associated with tamoxifen therapy and pelvic radiation. The most characteristic clinical feature is a recurrent cervical polypoid lesion. Patients have often had previous biopsies for the same reason, but without an accurate diagnosis. Furthermore, a mistaken diagnosis may have been made, the most common being cervical polyp. Uterine adenosarcoma consists of neoplastic glands with a benign appearance and a sarcomatous stroma. We report the case of a 53-year-old woman with a uterine polypoid lesion. After macroscopic, microscopic and immunohistochemical studies, the diagnosis was a uterine Müllerian adenosarcoma, which is a low-grade neoplasm with good prognosis, but with a high percentage of recurrences (25%-40%). Treatment is simple hysterectomy with double adnexectomy, with the option of subsequent postoperative radiotherapy. However, because this tumor is a low-grade neoplasm, a more conservative approach has sometimes been adopted in some young patients without children. This tumor is malignant, however, and mortality from abdominal or other types of metastases has been reported. Therefore, we believe that the most appropriate and safest therapeutic option is hysterectomy(AU)

Uterine inversion in association with uterine sarcoma: a case report with MRI findings and review of the literature.

Non-puerperal uterine inversion due to uterine sarcomas represents a very rare event with no reliable estimate of frequency in the literature. Clinically, the diagnosis of inversion may be difficult, as far as imaging procedures are concerned, although ultrasonography may prove to be useful. However, some characteristics such as the indentation of the fundic area and a depressed longitudinal groove extending from the uterus to the center of the inverted portion are difficult to recognize. Moreover, there is no specific computed tomography feature accurate enough to aid in the differential diagnosis. Here, we report a case of uterine inversion due to Müllerian uterine adenosarcoma whose preoperative workup and diagnosis took advantage of the application of magnetic resonance imaging.

Emergency endovascular nanopharmacologic treatment in advanced gynecological cancers.

INTRODUCTION: Advanced cases of uterine carcinomas with parametrial and fornix infiltration often cause massive genital bleeding, with severe anemia, fast deterioration, and a high risk of death for patients; women with advanced uterine cancer (UC) and genital massive bleeding were treated using an endovascular therapy in local anesthesia. METHODS: Ten women with advanced UC and genital massive bleeding were hospitalized for a high risk of immediate death; after blood transfusions and resuscitation therapy, the patients were submitted to an experimental nanopharmacologic endovascular therapy in local anesthesia. RESULTS: On average, the total operative time for the procedure was 38.6 minutes, the intrasurgical blood loss was of 37 mL, the postoperative analgesic request for 48 hours was just for 3 patients (all dismissed in the second day after pelvic artery embolization), the hemoglobin level at dismissal was of 6.5 g/L, and the duration of hospital stay was 1.4 days. All patients well tolerated the procedure, with no linked complications; clinical check was at the 10th and 30th days after dismissal, with no further recurrent genital bleeding in the follow-up course stopped at the visit in the 60th day. CONCLUSIONS: Genital bleeding in advanced UC is a serious complication because it causes deterioration of the patient's general status and has a worse prognosis. The pelvic uterine embolization according to our endovascular nanopharmacologic methods is bloodless, less traumatic, and faster than a surgical procedure. Even if it requires experience in intervention radiology, it enables the continuation of external radiotherapy without delay and can replace laparotomic or laparoscopic treatment.

[Atypical endometriosis: a clinicopathologic study of 163 cases].

OBJECTIVE: To investigate the clinicopathologic features of atypical endometriosis (AEM) and to discuss the relationship between AEM and tumors. METHODS: A retrospective analysis was performed of 163 cases of AEM, which were retrieved from the Department of Pathology files at the Tianjin Central Obstetrics and Gynecology Hospital between Jan 2004 and Dec 2006. The pathologic changes of AEM including its glandular epithelium, stroma, background and the conditions coexisting with tumor were observed. RESULTS: The AEM accounted for 4.38% (163/3724) of the endometriosis (EM) cases. Of 172 AEM foci of 163 patients, 168 were in the ovary, and the other 4 were in the fallopian tube, cervix and uterine serosa respectively. The rate of ovarian AEM was 6.81% of endometriosis. AEM associated with tumour was found in 26 cases (15.95%) and among 27 of ovarian AEM, 15 were malignant, 9 borderline and 3 benign. The AEM epithelia were mainly arranged in the form of surface epithelium. They present with characteristic features of moderate to marked pleomorphism, epithelial tufting and bud structures by microscopy. The walls of AEM cyst were presented with three layers of epithelium, endometrioid stroma and fibrosis-collagen. The endometrioid stroma were usually thin in contrast to the fibro-collagen tissue, which was often thick with scarred background. The transformation from AEM to tumor was found in most of the malignant tumors (14/15, 93%). CONCLUSIONS: AEM lesions hold some features of both EM and tumor, which may have a relatively higher potential for tumorigenesis and canceration. The process of damage and repair in EM foci during a long course may play a role in the development of EM into AEM and finally into tumor.

Adenosarcoma arising in inguinal endometriosis.

BACKGROUND: Adenosarcoma arising in inguinal endometriosis is a rare clinical entity. CASE: A 47-year-old nulligravida presented with a persistent and enlarged right groin mass. Sixteen years earlier she had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis and was placed on estrogen therapy. Surgical en bloc excision of the 12 x 4 cm inguinal mass revealed adenosarcoma arising in endometriosis. CONCLUSION: Although a rare entity, adenosarcoma arising in inguinal endometriosis should be included in the differential diagnosis for those patients with a history of endometriosis and chronic unopposed estrogen therapy who present with a groin mass.

Adenosarcoma ovárico con componente heterólogo / Ovarian adenosarcoma with a heterologous component

El adenosarcoma mülleriano es un tumor bifásico constituido por un componente glandular benigno, ocasionalmente con atipias, asociado a un componente mesenquimal maligno. El adenosarcoma ovárico tiene un peor pronóstico que su homónimo uterino. En dos tercios de los casos se produce recidiva tumoral y casi siempre en los primeros 5 años tras el diagnóstico. En pacientes en estadio I, la edad menor a 53 años, la rotura tumoral, el alto grado y el sobrecrecimiento estromal se asocian a una alta tasa de recidiva. Presentamos un caso de adenosarcoma ovárico en estadio Ia diagnosticado en nuestro centro, con recidiva precoz, y revisamos la bibliografía (AU)

Mullerian adenosarcoma is a bifasic tumour composed of a benign glandular component, occasionally with atypical cells, associated with a malignant mesenchymal component. The sarcomatous portion of the adenosarcoma may vary from low to very high grade, and its clinical behavior may be inactive or aggressive. Generally they originate in the uterus. Extrauterine sites are infrequent, but may be in the ovaries, fallopian tubes or the peritoneal mesothelium. We describe a case of ovarian adenosarcoma with early pelvic recurrence, and review the literature (AU)

Adenosarcoma uterino. Nuestra casuística / Uterine adenosarcoma. Our experience

El adenosarcoma uterino es un tumor mixto, poco frecuente, que histológicamente se caracteriza por un componente epitelial benigno asociado a un componente mesenquimal sarcomatoso. El síntoma clásico de presentación es la hemorragia vaginal ocasionalmente asociada a dolor pélvico. El tumor presenta un bajo potencial maligno, pero requiere seguimiento clínico a largo plazo. Presentamos los 2 casos de adenosarcoma uterino diagnosticados en nuestro hospital en los últimos 10 años (AU)

Endometriosis of the liver containing mullerian adenosarcoma: case report.

We present a case of a liver endometrioma in a postmenopausal woman. After failed management with leuprolide acetate, the mass was resected and contained focal areas of mullerian adenosarcoma. This is a rare case of mullerian adenosarcoma that appeared to arise within an endometrioma of the liver.

Adenosarcoma of the uterus: a case report.

Adenosarcomas of the uterus are very rarely observed and diagnosed. In this report, we present a case of a uterine adenosarcoma that was diagnosed in February 2002.

[Pulmonary embolism to the rescue in cardiac tamponade]. / L'embolie pulmonaire au secours de la tamponnade cardiaque.

The association of cardiac tamponade and pulmonary embolism has not previously been described. We report the case of a patient, who presented with such an association, due to an underlying pulmonary carcinoma. When a major pericardial effusion is associated with pulmonary hypertension, some echocardiographic signs of tamponade may appear, such as a moderate right ventricular collapse, or the absence of a paradoxical septum. The presence of pulmonary hypertension in this context of tamponade may have paradoxically saved the life of this patient.

Primary peritoneal mullerian adenosarcoma with sarcomatous overgrowth associated with endometriosis: a case report.

We report a primary peritoneal mullerian adenosarcoma with sarcomatous overgrowth associated with endometriosis in a 50-year-old female. The tumor formed multiple peritoneal masses occupying the pelvis and subdiaphragmatic space. Histologically, the tumor was composed of benign-appearing mullerian glands surrounded by a sarcomatous stroma. In addition, one perisplenic mass was largely devoid of the epithelial component and was of higher grade than the remaining lesions. Multiple foci of endometriosis were associated with the pelvic masses. To our knowledge, primary peritoneal mullerian adenosarcoma with sarcomatous overgrowth associated with endometriosis has not been previously reported.

Adenosarcoma in a patient with vaginal endometriosis.

BACKGROUND: Adenosarcoma in a patient with extraovarian endometriosis is a rare event and can be easily overlooked. CASE: A woman with a history of endometriosis underwent multiple resections of a vaginal mass and medical treatment for presumed recurrent endometriosis. Eventually, a vaginal adenosarcoma was diagnosed. CONCLUSION: The possibility of adenosarcoma should be considered if an enlarging mass occurs at the site of extraovarian endometriosis.

Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types.

One thousand consecutive cases of surgically proven endometriosis were reviewed to evaluate the frequency and types of pelvic cancers that were associated with ovarian and extraovarian endometriosis. The frequency and types of histologic abnormalities present in the eutopic endometrium when cancers were noted in endometriosis were also evaluated. In the large subset of cases for which the authors were the primary pathologists and all foci of endometriosis were recorded, the frequency of malignancy was 10.8%. In contrast, the frequency was only 3.2% in cases diagnosed by others previously in our institution. Cancers were more commonly found in ovaries when endometriosis was present in that ovary (5%) compared to when endometriosis was present at other sites (1%). Clear cell and endometrioid carcinomas were the malignancies most commonly seen in ovaries containing endometriosis, while clear cell adenocarcinoma and adenosarcoma were most commonly seen in conjunction with extraovarian endometriosis. The association of endometriosis with endometrioid and clear cell carcinoma was much stronger than that of serous and mucinous tumors (p < .01). Concurrent endometrial pathology was commonly seen in cases of malignant transformation of endometriosis (32% of cases).

Neoplastic and pre-neoplastic changes in gastrointestinal endometriosis: a study of 17 cases.

The clinicopathologic features of neoplasms arising in gastrointestinal endometriosis have not been well characterized. In this series, we report 17 cases of gastrointestinal endometriosis complicated by neoplasms (14 cases) or precancerous changes (three cases). Four patients, one of whom also had hypermenorrhea, presented with chronic abdominal pain and five had obstructive symptoms; one of these also had rectal bleeding. One patient presented with an acute abdomen and fecal peritonitis, one had vaginal bleeding, and one had a progressive change in bowel habits. Nine patients had a long history of endometriosis, 11 patients had had hysterectomies, and eight of these had also received unopposed estrogen therapy. The lesions involved the rectum (6), sigmoid (6), colon, unspecified (2), and small intestine (3), and comprised 8 endometrioid adenocarcinomas (EA), 4 mullerian adenosarcomas (MAS), 1 endometrioid stromal sarcoma (ESS), 1 endometrioid adenofibroma of borderline malignancy (EBA) with carcinoma in situ, 2 atypical hyperplasias (AH), and one endometrioid adenocarcinoma in situ (ACIS). The tumors ranged in size from 2 to 15 cm and all involved the serosa and muscularis propria. Two tumors extended into the mucosa, with mucosal ulceration in one. Follow-up was available in 11 cases. One patient with EA was dead of disease at 1 year, one had two recurrences at 1 and 2 years, and three were alive with no evidence of disease (ANED) at 9 months to 13 years (mean, 68 mos). The patient with the EBA was ANED at 3 months. Two patients with MAS were ANED at 2 and 3 years. The patient with ESS had a recurrence at 3 years and was ANED 6 years after her original diagnosis. One woman with AH was ANED at 60 months and the patient with ACIS was ANED at 16 months. One of the carcinomas was originally misdiagnosed as a primary intestinal adenocarcinoma. The pathologist should be aware of the possibility of a tumor of genital tract type when evaluating intestinal neoplasms in females, particularly if they have a history of endometriosis and have received unopposed estrogen therapy.