MULLERIAN ADENOSARCOMA PRESENTING AS CERVICAL POLYPS - A REPORT OF 7 CASES AND REVIEW OF THE LITERATURE

Objective: To emphasize the importance of early diagnosis in cases of mullerian adenosarcoma that appeared as benign-looking cervical polyps . Methods: We examined seven cases of mullerian adenosarcoma of the ut erus in patients 14-63 years of age (median 39 years). Tissue protrudi ng from the external os and an initial diagnosis of a cervical polyp w ere common findings for all patients. On repeated examination, all les ions were interpreted as mullerian adenosarcomas. Results: Histologic examination demonstrated benign glands with a sarcomatous stroma, whic h typically formed periglandular cuffs of increased cellularity. The s arcomatous stroma was homologous in four cases and contained heterolog ous elements such as striated muscle, lipoblast, and cartilage in thre e cases; one patient had a sarcomatous overgrowth of stromal elements. The question of a mullerian adenofibroma versus adenosarcoma was rais ed in three cases with the general appearance of slit-like glands surr ounded by a stroma with fibrosis and a low mitotic rate. Using the cri teria of stromal cellularity-marked stromal atypia and a mitotic index of two figures per ten high-power fields-the cases were classified as adenosarcomas. The sarcomatous overgrowth, the presence of heterologo us elements, and a high mitotic rate seem to be important prognostical ly. Conclusion: Gynecologists and pathologists should be aware of the difficulties and delay in the diagnosis of mullerian adenosarcoma when the tumor presents as a benign-looking cervical polyp.