Ovary tumor
Other tumors not specific to ovary
Müllerian adenosarcoma

Author: Nalini Gupta, M.D. (see Authors page)

Revised: 5 July 2016, last major update December 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Mullerian adenosarcoma [title] ovary
Cite this page: Müllerian adenosarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/ovarytumormullerianadeno.html. Accessed December 4th, 2016.
Definition / General
  • Ovarian MMMT are either low grade (müllerian adenosarcoma) or high grade (carcinosarcomas, mixed mesodermal tumors)
  • Müllerian adenonosarcomas are usually unilateral, more commonly seen in endometrium and cervix
  • 67% have tumor rupture at or before excision
  • Poorer prognosis than uterine adenosarcoma, perhaps due to greater ease of peritoneal spread
  • Tends to recur as pure sarcoma or adenosarcoma (Am J Surg Pathol 2002;26:1243)
Epidemiology
Pathophysiology
Clinical Features
  • Abdominal or pelvic pain, abdominal swelling, may present as adnexal mass
Laboratory
Radiology Description
  • MRI: solid pelvic mass, especially in patients with endometriosis
  • USG: very low resistive index (Ultrasound Q 2007;23:189)
Prognostic Factors
  • Poor prognostic factors: extraovarian spread (high stage), tumor rupture, high grade, high grade sarcomatous overgrowth, < age 53 years
  • Survival: 5 year-64%, 10 year-46%
Case Reports
Treatment
  • Salphingopherectomy or panhysterectomy
Gross Description
  • 97% unilateral, mean 14 cm (range 5-50 cm)
  • Usually solid with occasional small cysts
Gross Images

Images hosted on other servers:

Bilateral ovarian masses

Micro Description
  • Benign or atypical epithelial component and a low grade malignant stromal component
  • Conspicuous non-invasive mullerian type glands within a predominant malignant stroma, either homologous or heterologous
  • Periglandular cuffs of cellular stroma (80%), intraglandular protrusions of cellular stroma (60%) or both
  • At least mild stromal atypia (33%)
  • Variable stromal mitotic count; usually marked stromal cellularity (resembling endometrial stromal sarcoma or cellular ovarian fibroma) but may also have hypocellular stromal areas
  • Other features: glands widely spaced throughout stroma (90%), occasional sarcomatous overgrowth (30%), sex cord-like elements (15%), heterologous elements (12%)
Micro Images

Images hosted on other servers:

Large endometriotic cyst wall

Irregularly dilated endometrial glands

CD10, MIC2, calretinin, progesterone receptor, MIB1

Positive Stains
Differential Diagnosis
  • Benign tumors (adenofibroma or endometriosis): lack periglandular cellular cuffs of cellular stroma, no stromal atypia
  • Endometrial stromal sarcoma: sample thoroughly to rule out glandular component
  • Immature teratoma: younger patient, usually embryonal neuroectodermal elements, no periglandular cellular cuffs of cellular stroma
  • Malignant mixed müllerian tumor: glandular and stromal epithelium is obviously malignant vs. at most atypical glands in stromal sarcoma