Ovary
Mixed epithelial and mesenchymal tumors
Müllerian adenosarcoma
Author: Nalini Gupta, M.D.
Last author update: 1 December 2014
Last staff update: 22 October 2020
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Müllerian adenosarcoma [title] ovary
Table of Contents
Definition / general | Epidemiology | Pathophysiology | Clinical features | Laboratory | Radiology description | Prognostic factors | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Gupta N. Müllerian adenosarcoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarytumormullerianadeno.html. Accessed April 18th, 2024.
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)
Epidemiology
- Median age 54 years, range 30 - 84 years (Am J Surg Pathol 2002;26:1243)
Pathophysiology
- Appears to have epithelial origin (Am J Surg Pathol 1990;14:317, Am J Surg Pathol 1995;19:666)
Clinical features
- Abdominal or pelvic pain, abdominal swelling, may present as adnexal mass
Laboratory
- No useful biochemical marker (Curr Opin Obstet Gynecol 2006;18:20)
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
- 34 year old woman with abdominal pain and a large right multicystic ovarian mass (Arch Pathol Lab Med 2004;128:1057)
- Ovarian adenosarcoma with extensive deciduoid morphology arising in endometriosis (Int J Gynecol Pathol 2008;27:398)
- Ovarian adenosarcoma arising from benign cystadenoma and associated intraoperative consultation pitfalls (Int J Gynecol Pathol 2010;29:415)
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
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
Images hosted on other servers:
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
