ovarian mesodermal adenosarcoma

Mesodermal adenosarcoma of the ovary occur in women 30-84 years of age (mean 54 years). Abdominal discomfort and distension were the usual complaints.

In the main series published, all the patients are treated with an oophorectomy, which is accompanied by a hysterectomy in 85%, a contralateral oophorectomy in 65%, and nonsurgical therapy in 28%. Tumor rupture occurred at or before the operation in 67% of the cases.

The tumors are unilateral in 97.5% of the cases and 5.5-50 cm (mean 14 cm) in greatest dimension.

Most of the tumors are predominantly solid but contained numerous small cysts.

Microscopic examination

 sarcomatous overgrowth in 12 tumors.
 Sex cord-like elements can be present (including sarcomatous overgrowth) and heterologous elements (including sarcomatous overgrowth).
 The highest mitotic index of the sarcomatous component is 1-25 (mean 6) mitotic figures per 10 high power fields.

Prognosis

Only 23% women who were followed postoperatively for > or=5 years were free of tumor. In other patients, recurrent tumor appeared at 0.4-6.6 years (mean 2.6 years) after operation as pure sarcoma (low grade or high grade) or adenosarcoma (with or without sarcomatous overgrowth).

The 5-, 10-, and 15-year survival rates are 64%, 46%, and 30%, respectively.

Age < 53 years, tumor rupture, a high grade, and the presence of high-grade sarcomatous overgrowth appeared to be associated with recurrence or extraovarian spread.

Ovarian adenosarcomas have a worse prognosis than uterine adenosarcomas, presumably because of the greater ease of peritoneal spread. Many of the tumors caused problems in differential diagnosis.

Open references

 Osteoid differentiation in mesodermal (mullerian) adenosarcoma of ovary. Patel T, Gupta A, Trivedi P, Shah M. J Cancer Res Ther. 2013 Jul-Sep;9(3):529-31. doi : 10.4103/0973-1482.119371 PMID: 24126001 [Free]

 Low-grade Müllerian adenosarcoma with prominent decidualization, involving bilateral ovaries against a background of endometriosis: a diagnostic and treatment challenge.
Shah A, Rekhi B, Maheshwari A, Jambhekar NA. J Postgrad Med. 2013 Apr-Jun;59(2):149-52. doi : 10.4103/0022-3859.113833 PMID: 23793320 [Free]

References

 Mesodermal (müllerian) adenosarcoma of the ovary: a clinicopathologic analysis of 40 cases and a review of the literature. Eichhorn JH, Young RH, Clement PB, Scully RE. Am J Surg Pathol. 2002 Oct;26(10):1243-58. PMID: 12360039

 Adenosarcoma of the ovary. A light- and electron-microscopic study with review of the literature. Czernobilsky B, Gillespie JJ, Roth LM. Diagn Gynecol Obstet. 1982 Spring;4(1):25-36. PMID: 6280945

 Benign and low grade variants of mixed mesodermal tumor (adenosarcoma) of the ovary and adnexal region. Kao GF, Norris HJ. Cancer. 1978 Sep;42(3):1314-24. PMID: 698918