1. 醫學五 楊世慧 詹舜文 屠冠翔
pathology

2. 2007/11/26 Breast Partial mastectomy
Invasive ductal carcinoma, Grade 3 , pT1bN1Mx
HER-2/Neu: 1+, negative
ER: 70% strongly positive
PR: 50% strongly postive

3. 2010-7-20 Endometrium curettage
左：Viable polypoid fragments、Small inactive glands
右：Polypoid surface、Hypercellular Stromal spindle cells

4. Prominent Necrosis and hemorrhage

5. 左：Hypercellular stroma beneath surface epithelium
右：cleft-like Benign Inactive endometrial glands with periglandular stromal cuffing

6. Edematous/myxoid areas
Fascicular pattern, low grade nuclei

7. Relatively lower grade, spindled cells
higher cellularity, rounder epithelioid, pleomorphic cells with numerous mitosis

8. CD10
CD10 positive in stromal component, negative in glands

9. 2010/07/20 Uterus, endometrium, curettage
-----malignant Tumor, favor adenosarcoma
with sarcomatous overgrowth

10. Adenosarcoma Microscopic findings
Benign epithelial component:
Resembles inactive or proliferative endometrial epithelium
Malignant mesenchymal component:
Low-grade sarcoma
Resembles ESS, fibrosarcoma
Periglandular cuffs: hypercellularity
May contain heterologous elements

11. Immunohistochemistry
Epithelial component
Keratin (+), ER (+), PR (+)
Mesenchymal component
Cytoplasmic CD 10 (+)
Nuclear ER (+), PR (+), WT-1 (+)
Smooth muscle actin sometimes (+), desmin (+)

12. Differential Diagnosis
Adenofibromas
Benign epithelial and stromal components
paucicellular stroma , no periglandular cuffing, no stromal atypia
Benign endometrial polyp
inactive glands, No periglandular cuffing , no stromal mitoses
Atypical polypoid adenomyoma
Atypical epithelial component and benign stromal component
cellular smooth muscle ,glandular component with squamous morules

13. Malignant mixed mullerian tumor (MMMTs)
Malignant epithelial and stromal components
carcinomatous glandular component
Endometrial stromal sarcomas
Malignant stromal component only
no glandular component

14. Sarcomatous overgrowth
Uncommon variant
a benign glandular component
sarcomatous portion constituting more than 25% of the tumor
Higher grade and higher mitotic rate
High recurrence and mortality, comparable to carcinosarcoma

15. 2010/08/06 Uterus, Endometrium, total Hysterectomy
Bilateral salpingooophorectomy
Pelvic lymph node dissection
Partial omentectomy

16. Gross Features
Endometrial polypoid tumor occupying the endometrial cavity and measuring 7.5 x 5 x 4.2 cm. Foci of necrosis and hemorrhage present.
No definite myometrial invasion grossly
Ovaries: no tumor
Omentum: 4.1 x 2.8 x 0.4 cm, no tumor

17. Noncancer areas: Benign endometrial polyps
Irregularly distributed proliferative glands with cystic dilatation
Fibrotic stroma
Aggregates of thick walled blood vessels

18. Sarcomatous overgrowth
Stromal overgrowth with myometrial invasion

19. High grade stromal overgrowth with numerous mitosis

20. Diagnosis Uterine adenosarcoma with sarcomatous overgrowth
Myometrial invasion less than 25% of myometrial wall thickness
All else negative

21. 2011 / 02/ 18 Intra-abdomen tumor resection with right hemicolectomy
28cm colon and 56cm ileum
19.2 x 14.7 x 10 cm mass adhered to bowel serosa
Hemorrhage and necrosis

22. 左：Hyper nodules separated by fibrotic hypocellular tissue
右：Hypercellular ----high grade atypia, frequent mitosis

23. Omentectomy Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm
左：Many nodules of Tumor metastasis
Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm

24. Reference
[1] Piura B, Rabinovich A, Meirrovitz M, Yanai I. Müllerian adenosarcoma of the uterus: case report and review of literature. Eur J Gynecol Oncol ;21:387–390.
[2] American Cancer Society, Inc
[3] Atlas of Gynecologic Surgical Pathology
[4] Blaustein’s pathology of the female genital tract , fourth edition