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Open Access Case report

Cervical Mullerian Adenosarcoma with heterologous sarcomatous overgrowth: a fourth case and review of literature

Tito Silvio Patrelli12, Salvatore Gizzo1*, Stefania Di Gangi1, Giorgia Guidi1, Mario Rondinelli1 and Giovanni Battista Nardelli1

Author Affiliations

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

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

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BMC Cancer 2011, 11:236  doi:10.1186/1471-2407-11-236

Published: 11 June 2011

Abstract

Background

Uterine sarcomas are relatively rare tumors that account for approximately 1-3% of female genital tract malignancies and between 4-9% of uterine cancers. Less than 8% of all cases are Mullerian adenosarcoma, a distinctive uterine neoplasm characterized by a benign, but occasionally atypical, epithelial and a malignant, usually low-grade, stromal component, both of which should be integral and neoplastic constituents of the tumor. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very aggressive variant, associated with post-operative recurrence, metastases, even when diagnosed in early stage.

Case Presentation

We present a fourth MASO case derived from uterine cervix in a 72-year-old woman with metrorrhagia and a polypoid mass protruding through the cervical ostium. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic lymph node dissection, omental biopsy and appendectomy were performed. Surgery treatment was associated with adjuvant whole-pelvis radiation (45 Gy) and adjuvant chemotherapy (cisplatin/ifosfamide). After nine months of follow up, the patient was free of tumor.

Conclusions

The rarity of MASO of the cervix involves a management difficult. Most authors recommend total abdominal hysterectomy, usually accompanied by bilateral salpingo-oophorectomy. There is no common agreement on staging by lymphadenectomy during primary surgery and adjuvant chemo-radio therapy.