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364 Rare mullerian adenosarcoma of the uterine cervix on a background of endometriosis – a diagnostic challenge with risk of malignant transformation: a case report and review of the current literature
  1. Hannah Bruguier1,
  2. Natalie Maalouf1,
  3. Sarah Smyth1,
  4. Stephen Damato2 and
  5. Hooman Soleymani Majd3
  1. 1Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK
  2. 2Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
  3. 3Department of Gynaecological Oncology, Churchill Hospital, Oxford, UK

Abstract

Introduction/Background Mullerian adenosarcomas are rare tumours characterised by benign epithelial and malignant stromal elements, with 10% of these tumours being of cervical origin.

They present in pre-menopausal women with lower abdominal pain or abnormal vaginal bleeding, including menorrhagia and dysmenorrhoea.

Methodology We present the case of a 41-year-old nulliparous female awaiting surgical management of endometriosis for associated symptoms, which were not improved by medical treatments. Pre-operative MRI reported an incidental finding of an endocervical polyp, which was removed during hysteroscopic dilation and polypectomy. Histology demonstrated the polyp to be an adenosarcoma of the uterine cervix. We carried out a literature review looking at the potential link between adenosarcoma of the uterine cervix and endometriosis, and looking at the management of Mullerian adenosarcoma including fertility-sparing surgery and the use of radiotherapy, chemotherapy and hormonal therapy.

Results Adenosarcoma secondary to endometriosis has been reported in the literature, most commonly in extra-uterine cases. This situation can cause diagnostic challenge due to similar symptom profiles, and with low-grade tumours being mistaken for benign polyps. However, endometriosis may also be a positive prognostic factor. Patients with confined tumours who wish to preserve their fertility may be managed with local excision alone despite risk of local recurrence. Radiotherapy, chemotherapy and hormonal therapy have not been shown definitively to improve survival in Mullerian adenosarcoma, consolidating surgery as the mainstay treatment.

Conclusion This case presents an opportunity to add to the limited literature on this rare pathology, whilst assisting in building a consensus opinion for optimal management, including fertility-sparing protocols; under circumstances where formal guidelines do not exist.

Disclosures No conflict of interests to disclose.

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