Müllerian Adenosarcomas of the Uterus with Sarcomatous Overgrowth

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Abstract
Ten cases of müllerian adenosarcoma of the uterus with sarcomatous overgrowth are described. The tumors were found in women 32 to 82 years of age (median, 59), most of whom presented with abnormal vaginal bleeding and an enlarged uterus. At the time of abdominal hysterectomy, performed in all the cases, bilateral ovarian and peritoneal metastases were found in one patient. Gross examination of the uterus revealed bulky polypoid masses filling the endometrial cavity. In six cases, these masses invaded the myometrium. In three of them, they reached the serosa. Histological examination in each case revealed typical adenosarcoma overgrown by a pure sarcoma that accounted for 25% to 80% of the tumor. In seven tumors, the pure sarcoma was of higher grade and exhibited a higher mitotic rate than the sarcomatous component of the associated adenosarcoma, whereas in three tumors, the two sarcomatous components were similar in appearance. On follow-up, three patients were alive with no evidence of recurrent tumor at postoperative intervals of 4 to 7 years. Recurrent tumor developed in the other seven patients, including hematogenous metastases in four of them, at intervals of 9 months to 6 years. Six patients died from tumor progression at intervals of 9 months to 10 years. This study indicates that, in contrast to typical müllerian adenosarcomas of the uterus, adenosarcomas with sarcomatous overgrowth are aggressive tumors frequently associated with postoperative recurrence or metastases and a fatal outcome.

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