Uterine adenosarcoma is a rare malignancy. It is defined as a biphasic tumor composed of both sarcomatous stroma and benign epithelium. While the sarcomatous component usually is a low-grade homologous uterine sarcoma, the epithelium most often consists of endometrium-like cells. If the sarcomatous part occupies more than 25% of the tumor volume, the situation is referred to as sarcomatous overgrowth - accounting for about 10% of cases. While adenosarcoma usually may be considered a tumor of low malignant potential, the sarcomatous overgrowth most often presents as high-grade sarcoma and is associated with aggressive clinical behavior. Adenosarcomas stage I without sarcomatous overgrowth have a rather good prognosis, with a 5-year overall survival up to 80%. For treatment, complete surgical removal is advocated. Adjuvant chemotherapy and radiotherapy are not defined. Recurrences should again be treated surgically, attempting to achieve complete tumor resection. While the optimum medical treatment for relapsed and metastasized adenosarcomas has yet to be found, chemotherapy and endocrine therapy are potential options.

1.
Clement PB, Scully RE: Mullerian adenosarcoma of the uterus. A clinicopathologic analysis of ten cases of a distinctive type of Mullerian mixed tumor. Cancer 1974;43:1138-1149.
[PubMed]
2.
Zaloudek CJ, Hendrickson MR, Soslow RA: Mesenchymal tumors of the uterus; in Kurman RJ, Hedrick Ellenson L, Ronnet BM (eds): Blaustein's Pathology of the Female Genital Tract, ed 6. New York, Springer, 2011.
3.
Ulrich U: Maligne mesenchymale Tumoren - Sarkome und Mischtumoren; in Ulrich U (ed): Gynäkologische Onkologie. Ein Kompendium für die Klinik. Berlin, Walter de Gruyter, 2013.
4.
Fleming NA, Hopkins L, de Nanassy J, et al.: Mullerian adenosarcoma of the cervix in a 10-year-old girl: case report and review of the literature. J Pediatr Adolesc Gynecol 2009;22:e45-e51.
[PubMed]
5.
Shinnick JK, Kumar N, Beffa L, et al.: Management of low-grade cervical Müllerian adenosarcoma in a 14-year-old girl. J Pediatr Adolesc Gynecol 2017;30:652-654.
[PubMed]
6.
Liu H, Shen Z, Wu D, Zhou Y: Uterine adenosarcoma with sarcomatous overgrowth: a case report of aggressive disease in a 16-year-old girl and a literature review. J Pediatr Adolesc Gynecol 2018;31:426-431.
[PubMed]
7.
Seagle BL, Kanis M, Strohl AE, Shahabi S: Survival of women with Mullerian adenosarcoma: a National Cancer Data Base study. Gynecol Oncol 2016;143:636-641.
[PubMed]
8.
Mandato VD, Torricelli F, Mastrofilippo V, et al.: Primary extra-uterine and extra-ovarian Mullerian adenosarcoma: case report and literature review. BMC Cancer 2018;18:134.
[PubMed]
9.
McCluggage WG: Mullerian adenosarcoma of the female genital tract. Adv Anat Pathol 2010;17:122-129.
[PubMed]
10.
Wells M, Oliva E, Palacios J, Prat J: Mixed Epithelial and Mesenchymal Tumors of the Uterus. Lyon, IARC Press, 2014, pp 148-151.
[PubMed]
11.
Hodgson A, Amemiya Y, Seth A, et al.: High-grade Müllerian adenosarcoma: genomic and clinicopathologic characterization of a distinct neoplasm with prevalent TP53 pathway alterations and aggressive behavior. Am J Surg Pathol 2017;41:1513-1522.
[PubMed]
12.
Nathenson MJ, Conley A: Prognostic factors for uterine adenosarcoma: a review. Expert Rev Anticancer Ther 2018;18:1093-1100.
[PubMed]
13.
Carroll A, Ramirez PT, Westin SN, et al.: Uterine adenosarcoma: an analysis on management, outcomes, and risk factors for recurrence. Gynecol Oncol 2014;135:455-461.
[PubMed]
14.
Lee SJ, Park JY: A rare case of intramural Müllerian adenosarcoma arising from adenomyosis of the uterus. J Pathol Transl Med 2017;51:433-440.
[PubMed]
15.
Clement PB, Scully RE: Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol 1990;21:363-381.
[PubMed]
16.
Arend R, Bagaria M, Lewin SN, et al.: Long-term outcome and natural history of uterine adenosarcomas. Gynecol Oncol 2010;119:305-308.
[PubMed]
17.
Nathenson MJ, Ravi V, Fleming N, et al.: Uterine adenosarcoma: a review. Curr Oncol Rep 2016;18:68.
[PubMed]
18.
Howitt BE, Sholl LM, Dal Cin P, et al.: Targeted genomic analysis of Müllerian adenosarcoma. J Pathol 2015;235:37-49.
[PubMed]
19.
Hodgson A, Amemiya Y, Seth A, et al.: High-grade Müllerian adenosarcoma: genomic and clinicopathologic characterization of a distinct neoplasm with prevalent TP53 pathway alterations and aggressive behavior. Am J Surg Pathol 2017;41:1513-1522.
[PubMed]
20.
Lee JC, Lu TP, Changou CA, et al.: Genomewide copy number analysis of Müllerian adenosarcoma identified chromosomal instability in the aggressive subgroup. Mod Pathol 2016;29:1070-1082.
[PubMed]
21.
Friedlander ML, Covens A, Glasspool RM, et al.: Gynecologic Cancer InterGroup (GCIG) consensus review for Mullerian adenosarcoma of the female genital tract. Int J Gynecol Cancer 2014;24(9 suppl 3):S78-S82.
[PubMed]
22.
Denschlag D, Thiel FC, Ackermann S, et al.: Sarcoma of the uterus. Guideline of the DGGG (S2k-Level, AWMF Registry No. 015/074, August 2015). Geburtsh Frauenheilkd 2015;75:1028-1042.
[PubMed]
23.
Lee YJ, Kim DY, Suh DS, et al.: Feasibility of uterine preservation in the management of early-stage uterine adenosarcomas: a single institute experience. World J Surg Oncol 2017;15:87.
[PubMed]
24.
Gadducci A, Cosio S, Romanini A, et al.: The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 2008;65:129-142.
[PubMed]
25.
Machida H, Nathenson MJ, Takiuchi T, et al.: Significance of lymph node metastasis on survival of women with uterine adenosarcoma. Gynecol Oncol 2017;144:524-530.
[PubMed]
26.
Friedlander ML, Covens A, Glasspool RM, et al.: Gynecologic Cancer InterGroup (GCIG) consensus review for Mullerian adenosarcoma of the female genital tract. Int J Gynecol Cancer 2014;24(9 suppl 3):778-782.
[PubMed]
27.
Tanner EJ, Toussaint T, Leitao MM Jr, et al.: Management of uterine adenosarcomas with and without sarcomatous overgrowth. Gynecol Oncol 2013;129:140-144.
[PubMed]
28.
Nathenson MJ, Conley AP, Lin H, et al.: Treatment of recurrent or metastatic uterine adenosarcoma. Sarcoma 2017;2017:4680273.
[PubMed]
29.
Schroeder BA, Rodler ET, Loggers ET, et al.: Clinical benefit of trabectedin in uterine adenosarcoma. Med Oncol 2013;30:501.
[PubMed]
30.
Dahhan T, Fons G, Buist MR, et al.: The efficacy of hormonal treatment for residual or recurrent low-grade endometrial stromal sarcoma. A retrospective study. Eur J Obstet Gynecol Reprod Biol 2009;144:80-84.
[PubMed]
31.
Pinto A, Howitt B: Uterine adenosarcoma. Arch Pathol Lab Med 2016;140:286-290.
[PubMed]
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