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Uterus
Stromal tumors
Adenofibroma
Reviewer: Sanjay Logani, M.D., InCyte Pathology (see Reviewers page)
Revised: 14 June 2010, last major update June 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Benign counterpart of adenosarcoma, with benign glands and stroma
● First described in 1973 (Am J Clin Pathol 1973;60:543)
Epidemiology
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● Uncommon (much less common than adenosarcoma)
● Usually post-menopausal women
Sites
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● Usually arises from endometrium, but may be found in cervix, ovary, round and broad ligaments, pelvic wall
Etiology
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● Related to papillary adenofibroma, cystadenofibroma, lipoadenofibroma, adenomyomatosis
● May be extremely difficult to distinguish from low grade adenosarcoma (Am J Surg Pathol 2009;33:278)
● Some authors recommend classification as adenosarcoma of low malignant potential
Clinical features
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● Usually benign, rarely recurs (Gynecol Oncol 1990;3:427)
● Occasionally invades myometrium and pelvic veins (Int J Gynecol Pathol 1990;9:363)
● A difficult diagnosis based on curettings because adenosarcoma has variable cellularity
Prognostic factors
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● Criteria to determine malignant potential is similar to phyllodes tumors
● Malignant (adenosarcoma) if 2+ stromal mitotic figures/10 HPF, marked stromal cellularity with periglandular cuffing or significant stromal cell atypia
Case reports
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● 67 year old woman whose tumor had foci of mature adipose tissue (lipoadenofibroma, Arch Pathol Lab Med 1995;119:274)
● 68 year old woman with adenofibroma focally involved by adenocarcinoma (Am J Clin Pathol 1992;97:806)
Treatment
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● Hysterectomy is usually curative
● Recurrence is rare, and associated with conservative resection
Gross description (Macroscopy)
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● Polypoid, broad based
● Firm, papillary, multicystic
● No necrosis
Micro description (Histopathology)
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● Cleft like papillary architecture
● Comprised of benign glands and benign appearing stroma
● Surface epithelium often extends deeply into stroma
● Prominent cystic spaces
● Stroma is composed of benign appearing fibroblasts or endometrial stromal cells
● Variable epithelial lining (epithelioid, mucinous, serous)
● No stromal atypia, no periglandular cuffing, no/rare mitotic figures
Micro images
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Broad club-shaped papillae project Epithelial and stromal elements
into endometrial cavity are benign
Stroma is more cellular than usual, but Dense fibrous connective tissue
No atypia or cambium layer are present and glandular spaces
Differential Diagnosis
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● Adenosarcoma: more common than adenofibroma; periglandular condensation of stroma creating hyper- and hypocellular zones and formation of cambium layer, cellular and mitotically active stroma
End of Uterus > Stromal tumors > Adenofibroma
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