The Presence of Heterologous Elements Increases the Risk of Recurrence in Mullerian Adenosarcomas
V Dube, S Nofech-Mozes, N Ismiil, RS Saad, Z Ghorab, MA Khalifa. Sunnybrook Health Sciences Centre, Toronto, Canada
Background: Mullerian adenosarcomas (AS) are biphasic tumors composed of benign epithelium admixed with malignant sarcomatous stroma. They can arise from the endometrium (EAS), cervix (CAS) or ovaries (OAS) and have a potential for recurrence. In this study, we summarized our experience with these tumors in a tertiary care setting.
Design: Cases of AS (1993-2009) were retrieved from our pathology archives. All available slides and patients' charts were reviewed and the following data were recorded: patients' age, symptoms, treatment, tumor size, atypia, sarcomatous overgrowth (SO), heterologous elements, depth of invasion, lymphovascular invasion (LVI) and follow-up (FU). The association between various pathologic features and FU was analyzed using Fisher exact test.
Results: We identified 22 cases of AS (11 EAS, 8 CAS, 3 OAS) diagnosed in patients aged 33 to 66 years (median: 53 years). The main presenting symptom was abnormal bleeding for EAS and CAS and a pelvic mass for OAS. Twenty-one patients underwent hysterectomy and most of them also had BSO (19/22). One patient with OAS was treated with only salpingo-oophorectomy. Omental biopsy was performed in 10 patients (1 was positive for metastasis) and lymph nodes were biopsied in 7 (all were negative). Tumor size ranged from 1 to 16 cm (median = 6 cm). 9/19 (47.4%) cases of EAS and CAS showed no myoinvasion, 9/19 (47.4%) showed invasion limited to the inner half and only 1 (5.2%) showed invasion within the outer half. SO was present in 6 cases (27.3%) and heterologous elements in 7 cases (31.8%) (rhabdomyosarcoma, osteosarcoma, chondrosarcoma and liposarcoma). Ten cases showed mild stromal atypia, 8 moderate and 4 severe. Stromal mitotic activity ranged from 1 to 100/10HPFs (mean: 13, median: 3). Only 3 cases had LVI. FU information was available in all patients (1-117 months, median: 21.5); 17 patients were well with no evidence of disease, 5 recurred (3 EAS, 1 CAS, 1 OAS) at 7 to 42 months post-operatively. One EAS patient died of her disease. Patients with SO, myoinvasion and heterologous elements were at increased risk for recurrence, but only the presence of heterologous elements reached statistical significance (p=0.021).
Conclusions: Previous reports emphasized the presence of myoinvasion and SO as risk factors for recurrence in AS patients. Our results also show that the presence of heterologous elements is a significant histologic prognosticator for adverse outcome and therefore needs to be reported with adequate sampling of the resected specimen.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 152, Wednesday Morning