UTERINE AND EXTRAUTERINE MULLERIAN ADENOSARCOMA - A HISTOPATHOLOGIC AND FLOW CYTOMETRIC STUDY

Uterine adenosarcoma is a rare tumor of Mullerian origin and is charac terized by a benign glandular component and a sarcomatous usually low- grade, stroma, We examined 11 cases of Mullerian adenosarcoma, eight c ervical, two uterine and one of the peritoneum. Tissue protruding from the cervix and an initial diagnosis of a cervical polyp were common f indings for most patients with uterine adenosarcoma. On repeated exami nation these cases were re-evaluated as Mullerian adenosarcomas. Histo logic examination revealed benign glands with a sarcomatous stroma, wh ich typically formed periglandular cuffs of increased cellularity. The saromatous stroma was homologous in four cases but contained heterolo gous elements, such as striated muscle, lipoblasts and cartilage in th ree cases; in one case a sarcomatous overgrowth of stromal elements wa s found. The question of a Mullerian adenofibroma vs adenosarcoma was raised in three cases. According to stromal cellularity, stromal atypi a and mitotic rate, the cases were classified as adenosarcomas. Sarcom atous overgrowth, presence of heterologous elements and high mitotic r ate seem to indicate poor prognosis. Flow cytometry showed a predomina ntly diploid population of cells in eight cases of adenosarcoma. An an euploid cell population was seen in three cases of adenosarcoma and in all but one case of carcinosarcoma studied as controls. Gynecologists and pathologists should be aware of the difficulties and delay in the diagnosis of Mullerian adenosarcoma in cases when the tumor presents as a benign looking cervical polyp. Flow cytometric DNA analysis might serve as a useful tool in the diagnosis of Mullerian adenosarcoma vs carcinosarcoma and contribute to the prognostic evaluation in differen t histologic subsets of the tumor.