Seidman J D, Wasserman C S, Aye L M, MacKoul P J, O'Leary T J
Department of Pathology, Washington Hospital Center, DC 20010, USA.
Am J Surg Pathol. 1999 Jul;23(7):809-14. doi: 10.1097/00000478-199907000-00009.
Mullerian adenosarcoma is an uncommon variant of uterine sarcoma. Twelve uterine adenosarcomas were diagnosed during a 42-month period at the Washington Hospital Center in Washington, DC. Based on estimated incidence data derived from the US Department of Defense beneficiary population, an estimated relative risk of 15.4 (95% confidence interval, 7.7-31.0) was calculated, indicating a significantly increased incidence of adenosarcoma in the population studied (p<0.0000001). Among 10 patients who underwent hysterectomy, six (60%) of their tumors had sarcomatous overgrowth. In comparison with the previously reported proportion of adenosarcomas with sarcomatous overgrowth, approximately 16%, the proportion with sarcomatous overgrowth was significantly higher than expected (p<0.01). Mullerian adenosarcoma with sarcomatous overgrowth was first described in 1989 and suggests that the cluster of adenosarcomas reported herein may be due in part to the current classification of some uterine tumors as adenosarcoma with sarcomatous overgrowth that previously would have been classified as other types of uterine sarcoma. Nonetheless, even after reviewing and updating the classification of all sarcomas diagnosed at the Washington Hospital Center from 1985 to 1998, the ratio of adenosarcomas to uterine adenocarcinomas during the 1994-1998 period was 4.7 times (p<0.005) that of the 1985-1993 period, suggesting a more modest but real increase in the occurrence of this tumor. Correct classification of mullerian adenosarcomas with sarcomatous overgrowth is important because the limited available data suggest that the prognosis is notably worse than that for adenosarcomas without sarcomatous overgrowth.
苗勒管腺肉瘤是子宫肉瘤的一种罕见变异类型。在华盛顿特区的华盛顿医院中心，42个月期间诊断出12例子宫腺肉瘤。根据从美国国防部受益人群得出的估计发病率数据，计算出估计相对风险为15.4（95%置信区间，7.7 - 31.0），表明在所研究人群中腺肉瘤发病率显著增加（p<0.0000001）。在接受子宫切除术的10例患者中，6例（60%）的肿瘤存在肉瘤样过度生长。与先前报道的腺肉瘤伴有肉瘤样过度生长的比例约16%相比，伴有肉瘤样过度生长的比例显著高于预期（p<0.01）。伴有肉瘤样过度生长的苗勒管腺肉瘤于1989年首次被描述，这表明本文报道的腺肉瘤群可能部分归因于当前一些子宫肿瘤被分类为伴有肉瘤样过度生长的腺肉瘤，而这些肿瘤以前可能被归类为其他类型的子宫肉瘤。尽管如此，即使在回顾和更新了华盛顿医院中心1985年至1998年诊断的所有肉瘤的分类后，1994 - 1998年期间腺肉瘤与子宫腺癌的比例是1985 - 1993年期间的4.7倍（p<0.005），表明该肿瘤的发生率有较为适度但确实的增加。正确分类伴有肉瘤样过度生长的苗勒管腺肉瘤很重要，因为有限的现有数据表明其预后明显比没有肉瘤样过度生长的腺肉瘤更差。
