Mixed epithelial and mesenchymal tumors

Müllerian adenosarcoma

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PubMed Search: Müllerian adenosarcoma [title] ovary

Nalini Gupta, M.D.
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Cite this page: Gupta N. Müllerian adenosarcoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarytumormullerianadeno.html. Accessed June 5th, 2023.
Definition / general
  • Ovarian MMMT is either low grade (Müllerian adenosarcoma) or high grade (carcinosarcoma, mixed mesodermal tumor)
  • Müllerian adenonosarcoma is 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)
Clinical features
  • Abdominal or pelvic pain, abdominal swelling, may present as adnexal mass
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
  • 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

Microscopic (histologic) description
  • Benign or atypical epithelial component and a low grade malignant stromal component
  • Conspicuous noninvasive Müllerian 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%)
Microscopic (histologic) images

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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 versus at most atypical glands in stromal sarcoma
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