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[969] Mullerian Adenosarcoma: A Clinicopathologic and Immunohistochemical Study of 55 Cases

A Ribe, F Saro, F Peiro, J Prat. Hospital de la Santa Creu i Sant Pau. Autonomous University of Barcelona, Barcelona, Spain; Hospital General de Elda, Elda, Valencia, Spain

Background: Adenosarcoma (AS) is a rare polypoid mixed tumor of Mllerian origin composed of low-grade malignant endometrial stroma and benign epithelial glands. Its pathogenesis is unknown.
Design: A clinicopathologic and immunohistochemical study of 55 AS (49 uterine, 3 ovarian, 1 vaginal, 1 tubal, and 1 peritoneal) was done. Expression of selected proteins involved in tumorigenesis by means of increase cell proliferation (p16, p53, pRB, PTEN, ki67, MLH-1, MSH-2, EGFR, PDGFR and Cerb-B2), alteration of differentiation (B-Catenin, E-Cadherin, CD10, VIM, ER and PR), and dysregulation of the apoptotic pathways (p53, BAX, Bcl-2, FAS-L, P-Akt) were investigated using a tissue array with 30 AS.
Results: Patients age ranged from 13-86 years with a median of 50 years. History of hormonal therapy (5), tamoxifen (2), and radiotherapy (1) were recorded. The initial symptoms were vaginal bleeding (15), enlarged uterus (5) and abdominal pain (5). Sixteen AS showed sarcomatous overgrowth. Heterologous elements occurred in 13 cases and 9 tumors had myometrial invasion. Nineteen patients have been followed for 7 to 191 months. Five tumors metastasized and 2 recurred. Three patients died of tumor. PDGFR and EGFR were overexpressed in the stroma (70% and 27%, respectively) but were not detected in glands. pRb was frequently lost both in the stroma (57%) and glands (26%). p16 was overexpressed in the stroma (60%) and glands (29%). There were no significant alterations in proteins involved in apoptosis (Bax and Fas-L were detected both in glands and stroma (90%), whereas Bcl-2 was negative in both (>73%). The stromal proliferation index was >5% in 23% of cases. ER were detected in glands (60%) and stroma (30%) and PR were also expressed in both (60%). Nuclear staining for beta-catenin was seen in glands (42%), stroma (20%), or both (43%). E-Cadherine was only expressed in glands (40%). CD10 was only detected in the stroma (70%). MLH-1, MSH-2, and PTEN proteins were preserved in both components. Cerb-B2 was negative in both elements in all cases.
Conclusions: AS are highly differentiated tumors with a low proliferation index. They show a predominantly stromal growth characterized by overexpression of PDGFR, EGFR, and p16, loss of pRB, and nuclear accumulation of beta-catenin. There are no significant alterations in proteins involved in apoptosis and PTEN expression is preserved.
Category: Gynecologic

Monday, March 26, 2007 11:45 AM

Platform Session: Section C, Monday Morning