Open Access Highly Accessed Case report

Extragenital Müllerian adenosarcoma with pouch of Douglas location

Tito S Patrelli13*, Enrico M Silini2, Salvatore Gizzo14, Roberto Berretta1, Laura Franchi1, Elena Thai2, Adolf Lukanovic3, Giovanni B Nardelli14 and Alberto Bacchi Modena1

Author Affiliations

1 Department of Obstetrics, Gynecological and Perinatology Sciences; University of Parma, viale Gramsci 14, 43100 Parma, Italy

2 Department of Pathological Anatomy, University of Parma, viale Gramsci 14, 43100 Parma, Italy

3 Department of Maternal and Child Health, University of Ljubljana, Slajmerieva, 3-1000 Ljubljana, Slovenia

4 Department of Gynecological and Human Reproduction Sciences; University of Padua; via Giustiniani 3, 35128 Padua, Italy

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BMC Cancer 2011, 11:171  doi:10.1186/1471-2407-11-171

Published: 15 May 2011

Abstract

Background

Of all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Müllerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature.

Case Presentation

A 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Müllerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy.

Conclusions

The case of Müllerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst.