Elshafie Mona, Rahimi Siavash, Ganesan Raji, Hirschowitz Lynn
Birmingham Women's NHS Foundation Trust, Birmingham, UK.
Int J Surg Pathol. 2013 Apr;21(2):186-9. doi: 10.1177/1066896912453852. Epub 2012 Jul 20.
Müllerian adenosarcomas most commonly arise in the uterine corpus from the eutopic endometrium. Occasionally, they arise in the cervix, vagina, broad and round ligaments, and ovaries and rarely in extragenital sites, usually in association with endometriosis. The authors report a rare case of extraendometrial, intramural adenosarcoma of low grade arising from a subserosal adenomyoma in a 46-year-old woman who presented with vaginal bleeding. No evidence of eutopic endometrial origin was identified; the adenosarcoma showed only limited myometrial invasion and no serosal involvement. Because of its subserosal location, the tumor would be overstaged as IC (deeply myoinvasive) in the new FIGO staging system. Stage IC tumors would normally be considered for adjuvant treatment, which would be inappropriate in this case. To avoid overstaging and inappropriate treatment, it is important to recognize that adenosarcoma can, rarely, arise in adenomyomas (or adenomyosis).
苗勒管腺肉瘤最常见于子宫体部的在位子宫内膜。偶尔，它们也会发生于宫颈、阴道、阔韧带和圆韧带以及卵巢，极少发生于生殖器外部位，通常与子宫内膜异位症相关。作者报告了一例罕见病例，一名46岁出现阴道出血的女性，其肌壁间低级别腺肉瘤起源于浆膜下子宫腺肌病，并非来自在位子宫内膜。未发现有在位子宫内膜起源的证据；该腺肉瘤仅表现为有限的肌层浸润，未累及浆膜。由于其浆膜下位置，在新的国际妇产科联盟（FIGO）分期系统中，该肿瘤会被过度分期为IC期（深部肌层浸润）。IC期肿瘤通常会考虑进行辅助治疗，但在这种情况下并不合适。为避免过度分期和不恰当的治疗，认识到腺肉瘤极少可起源于子宫腺肌病（或子宫腺肌症）很重要。
