Skip to main content
SpringerLink
Log in

Uterine adenosarcoma: A clinicopathologic study of 11 cases with a reevaluation of histologic criteria

  • Original Papers
  • Published:
Archives of gynecology Aims and scope Submit manuscript

Summary

Eleven biphasic uterine tumors with epithelial components and homologous stroma were reevaluated. Originally these were diagnosed as adenofibroma, adenosarcoma, carcinosarcoma, or mixtures thereof, but were now reclassified as adenosarcomas of which seven were “pure” and four mixed with foci of carcinosarcoma. Nine of the tumors arose in the endometrium and two in the endocervix. The mean patient's age was 55 years. The most common complaint was vaginal bleeding. Macroscopically these tumors presented as polypoid masses. The epithelial component consisted mainly of endometrial, endocervical, ciliated, and clear cells. Squamous metaplasia and focal hyperplasia were occasionally observed. Malignant epithelial change was only present in foci of carcinosarcoma. The stroma showed prominent cellular periglandular cuffs, occasionally round solid or perivascular nodules, and areas of focal or diffuse stromal hypercellularity. In all these areas stromal cells were atypical and/or pleomorphic. Stromal foam cells were seen in three cases. Mitotic activity was low ranging from one to three mitoses per 10 high power fields (HPF). Follow-up was negative exept in two cases with recurrence and abdominal metastases. It was concluded that stromal hypercellularity with atypism and pleomorphism in periglandular, perivascular location as well as of focal or diffuse nature, is characteristic of uterine adenosarcoma. Adenofibromas present a fibro-collagenous stroma lacking the crowded cellular areas. Mitotic activity is too variable to serve as a reliable diagnostic criterion. Uterine adenosarcomas are usually tumors of low grade malignancy but the lack of correlation between histologic appearance and biologic behaviour precludes prognostication in the individual patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abell MR (1971) Papillary adenofibroma of the uterine cervix. Am J Obstet Gynecol 110: 990–993

    PubMed  Google Scholar 

  2. Ashkenazy M, Lancet M, Borenstein R, Czernobilsky B (1983) Endometrial foam cells: nonestrogenic and estrogenic. Acta Obstet Gynecol Scand (in press)

  3. Bibro MC, Li Volsi VA, Schwartz PE (1979) Adenosarcoma of the uterus. Ultrastructural observations. Am J Clin Pathol 71: 112–117

    PubMed  Google Scholar 

  4. Borello DJ, Wood WG, Newman RL (1979) Müllerian adenosarcoma. Two additional cases with ultrastructural observations. Am J Diagn Gynecol Obstet 1: 275–282

    Google Scholar 

  5. Clement PB, Scully RE (1974) Müllerian adenosarcoma of the uterus. A clinicopathologic analysis of 10 cases of a distinctive type of Müllerian mixed tumor. Cancer 34: 1138–1149

    PubMed  Google Scholar 

  6. Clement PB, Scully RE (1978) Extrauterine mesodermal (müllerian) adenosarcoma. A clinicopathologic analysis of five cases. Am J Clin Pathol 9: 276–283

    Google Scholar 

  7. Czernobilsky B, Borenstein R, Lancet M (1974) Cystadenofibroma of the ovary. A clinicopathologic study of 34 cases and comparison with serous cystadenoma. Cancer 34: 1971–1981

    PubMed  Google Scholar 

  8. Czernobilsky B (1977) Cystadenofibroma, adenofibroma and malignant adenofibroma of the ovary. In: Sommers SC (ed) Pathology annual, vol 12, part I. Appleton — Century — Crofts, New York, pp 201–216

    Google Scholar 

  9. Czernobilsky B, Katz Z, Lancet M, Gaton E (1980) Endocervical-type epithelium in endometrial carcinoma. A report of 10 cases with emphasis on histochemical methods for differential diagnosis. Am J Surg Pathol 4: 481–489

    PubMed  Google Scholar 

  10. Czernobilsky B, Gillespie JJ, Roth LM (1982) Adenosarcoma of the ovary. A light and electron-microscopic study with review of the literature. Diagn Gynecol Obstet 4: 25–36

    PubMed  Google Scholar 

  11. Czernobilsky B. Ungar H. Adler JH (1982) Spontaneous uterine neoplasms in the fat sand rat (Psammomys Obesus). Lab Animals 16: 285–289

    Google Scholar 

  12. Dallenbach-Hellweg G (1981) Histopathology of the endometrium, 3rd edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  13. Damjanov I, Casey MJ, Maenza RM, Kennedy AW (1978) Mü llerian adenosarcomas of the uterus. Am J Clin Pathol 70: 96–103

    PubMed  Google Scholar 

  14. Evans HL (1982) Endometrial stromal sarcoma and poorly differentiated endometrial sarcoma. Cancer 50: 2170–2182

    PubMed  Google Scholar 

  15. Fayemi AO, Ali M, Braun EV (1978) Müllerian adenosarcoma of the uterine cervix. Am J Obstet Gynecol 130: 734–735

    PubMed  Google Scholar 

  16. Fox H, Harilal KR, Youell A (1979) Müllerian adenosarcoma of the uterine body. A report of 9 cases. Histopathology 3: 167–180

    PubMed  Google Scholar 

  17. Gloor E (1979) Müllerian adenosarcoma of the uterus. Clinicopathologic report of five cases. Am J Surg Pathol 3: 203–209

    PubMed  Google Scholar 

  18. Grimalt M, Arguelles M, Ferenczy A (1975) Papillary cystadenofibroma of endometrium: A histochemical and ultrastructural study. Cancer 36: 137–144

    PubMed  Google Scholar 

  19. Hendrickson MR, Kempson RC (1980) Endometrial epithelial metaplasias: Proliferations frequently misdiagnosed as adenocarcinomas. Am J Surg Pathol 4: 525–542

    PubMed  Google Scholar 

  20. Kanbour AI, Burgess F, Salazar H (1973) Intramural adenofibroma of the fallopian tube. Cancer 31: 1433–1439

    PubMed  Google Scholar 

  21. Kao GF, Norris HJ (1978) Benign and low grade variants of mixed mesodermal tumor (adenosarcoma) of the ovary and adnexal region. Cancer 42: 1314–1324

    PubMed  Google Scholar 

  22. Katzenstein AAL, Askin FB, Feldman PS (1977) Müllerian adenosarcoma of the uterus: An ultrastructural study of four cases, Cancer 40: 2233–2242

    PubMed  Google Scholar 

  23. Mills PA, Greenberg H, Heviera G, Trujillo I (1982) Mü llerian adenofibroma of the endometrium. A report of a case with ultrastructural study. Diagn Gynecol Obstet 4: 215–221

    PubMed  Google Scholar 

  24. Okagaki T, Brooker DC, Adcock IX, Prem KA (1979) Mü llerian adenosarcoma of the uterus with rapid progression: an ultrastructural study. Gynecol Oncol 7: 361–1970

    PubMed  Google Scholar 

  25. Östör AG, Fortune DW (1980) Benign and low grade variants of mixed Müllerian tumor of the uterus. Histopathology 4: 369–382

    PubMed  Google Scholar 

  26. Roth LM, Pride GZ, Sharma HM (1976) Müllerian adenosarcoma of the uterine cervix with heterologous elements: a light and electron microscopic study. Cancer 37: 1725–1736

    PubMed  Google Scholar 

  27. Russell P, Slavutin L, Laverty CR, Cooper-Booth J (1979) Extrauterine mesodermal (müllerian) adenosarcoma. A case report: Pathology II, 557–560

  28. Silverberg SG (1975) Adenomyomatosis of the endometrium and cervix — a hamartoma? Am J Clin Pathol 64: 192–199

    PubMed  Google Scholar 

  29. Teilum G (1971) Special tumors of the ovary and testis and related extragonadal lesions. Comparative pathology and histological identification. J. B. Lippincott, Philadelphia and Munksgaard, Copenhagen

    Google Scholar 

  30. Thompson M, Husemyer R (1981) Carcinofibroma — a variant of the mixed müllerian tumor. Case report. Br J Obstet Gynecol 88: 1151–1155

    Google Scholar 

  31. Valdeg VA, Planas AT, Lopez VF, Goldberg M, Herrera NE (1979) Adenosarcoma of uterus and ovary: a clinicopathologic study of two cases. Cancer 43: 1439–1447

    PubMed  Google Scholar 

  32. Vellios F, Ng ABP, Reagan JW (1973) Papillary adenofibroma of the uterus: A benign mesodermal mixed tumor of Müllerian origin. Am J Clin Pathol 60: 543–551

    PubMed  Google Scholar 

  33. Vellios F (1980) Papillary adenofibroma — adenosarcoma; the uterine cystosarcoma phyllodes. Prog Surg Pathol 1: 205–219

    Google Scholar 

  34. Zaloudek CJ, Norris HJ (1981) Adenofibroma and adenosarcoma of the uterus: A clinicopathologic study of 35 cases. Cancer 48: 354–366

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Morphologische Abteilung der Frauenklinik im Klinikum Mannheim der Universität Heidelberg, (Director: Prof. Dr. P. Stoll), D-6800, Mannheim, Federal Republic of Germany

    B. Czernobilsky, P. Hohlweg-Majert & G. Dallenbach-Hellweg

Authors
  1. B. Czernobilsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Hohlweg-Majert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Dallenbach-Hellweg
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Professor of Pathology, Medical School of the Hebrew University and Hadassah, Jerusalem; Israel Chief, Dept. of Pathology, Kaplan Hospital Rehovot, Israel; Guest Professor, supported by the Deutsche Forschungsgemeinschaft (HE 208/95-1)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Czernobilsky, B., Hohlweg-Majert, P. & Dallenbach-Hellweg, G. Uterine adenosarcoma: A clinicopathologic study of 11 cases with a reevaluation of histologic criteria. Arch. Gynecol. 233, 281–294 (1983). https://doi.org/10.1007/BF02133803

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02133803

Key words

Search

Navigation