Definition/General
Introduction:
Cervical adenosarcoma is a rare biphasic malignant tumor characterized by benign epithelial (glandular) elements and malignant mesenchymal (stromal) components
It has better prognosis than carcinosarcoma but requires complete excision.
Origin:
Arises from cervical stroma with secondary incorporation of benign epithelial elements
Shows benign glandular epithelium surrounded by malignant mesenchymal stroma with increased cellularity.
Classification:
WHO Classification categorizes as adenosarcoma - biphasic tumor with benign epithelial and malignant mesenchymal components
May have homologous or heterologous sarcomatous elements.
Epidemiology:
Rare, represents <5% of cervical sarcomas
Peak incidence 45-65 years
Better prognosis than carcinosarcoma
May recur if incompletely excised.
Clinical Features
Presentation:
Abnormal vaginal bleeding
Polypoid cervical mass
Pelvic pain or pressure
May present as protruding mass through cervical os.
Symptoms:
Abnormal vaginal bleeding (most common)
Pelvic pain or discomfort
Visible polypoid lesion
Vaginal discharge
Pressure symptoms.
Risk Factors:
Middle-aged women (45-65 years)
History of pelvic radiation (some cases)
Tamoxifen exposure (controversial)
No clear hormonal association.
Screening:
Clinical examination reveals polypoid mass
Imaging shows heterogeneous cervical lesion
Tissue diagnosis required for confirmation.
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Gross Description
Appearance:
Polypoid, lobulated mass with smooth to bosselated surface
Firm consistency with softer areas
Cut surface shows solid, fleshy appearance.
Characteristics:
Size variable (2-10 cm)
Firm to soft consistency
Gray-white to tan coloration
Polypoid or sessile configuration
May have cystic areas.
Size Location:
Arises from cervical stroma
May protrude through external os
Can involve entire cervical canal
Extension to parametrium possible.
Multifocality:
Usually solitary mass
May have satellite nodules
Well-circumscribed to infiltrative borders depending on grade.
Microscopic Description
Histological Features:
Biphasic tumor with benign glandular epithelium surrounded by malignant mesenchymal stroma
Stroma shows increased cellularity, atypia, and mitotic activity
Periglandular stromal condensation characteristic.
Cellular Characteristics:
Epithelium: benign endocervical or endometrial-type glands
Stroma: malignant mesenchymal cells with nuclear atypia and increased mitoses.
Architectural Patterns:
Glands surrounded by cellular malignant stroma
Periglandular stromal condensation (hallmark feature)
May have leaf-like or phyllodes-like pattern.
Grading Criteria:
Low-grade: <5 mitoses per 10 HPF, mild atypia
High-grade: >5 mitoses per 10 HPF, marked atypia, may have heterologous elements.
Immunohistochemistry
Positive Markers:
Epithelium: cytokeratin, EMA positive
Stroma: vimentin positive, CD10 positive (endometrial stroma marker), specific markers for heterologous elements.
Negative Markers:
Variable based on stromal differentiation
SMA may be negative or focal
Desmin variable.
Diagnostic Utility:
Cytokeratin confirms benign epithelial component
Vimentin and CD10 support stromal origin
Specific markers identify heterologous elements.
Molecular Subtypes:
Low-grade vs
high-grade based on mitotic activity and atypia
Homologous (endometrial stroma) vs
heterologous (cartilage, bone, muscle).
Molecular/Genetic
Genetic Mutations:
Limited molecular data
No specific genetic alterations identified
Complex karyotype possible in high-grade lesions.
Molecular Markers:
Variable Ki-67 index based on grade
p53 alterations possible in high-grade lesions
Hormone receptor status variable.
Prognostic Significance:
Grade most important prognostic factor
Complete excision essential
High-grade lesions have worse prognosis and may transform to sarcoma.
Therapeutic Targets:
Complete surgical excision primary treatment
Adjuvant therapy for high-grade or incompletely excised lesions
Hormone therapy controversial.
Differential Diagnosis
Similar Entities:
Carcinosarcoma (malignant mixed Müllerian tumor)
Endometrial stromal sarcoma
Cervical polyp with atypical stroma
Phyllodes tumor.
Distinguishing Features:
Adenosarcoma: benign epithelium, malignant stroma
Carcinosarcoma: both components malignant
ESS: pure stromal tumor.
Diagnostic Challenges:
Recognition of benign epithelial component
Assessment of stromal malignancy
Grading based on mitotic activity
Sampling adequacy.
Rare Variants:
Adenosarcoma with sarcomatous overgrowth
Mixed adenosarcoma and endometrial stromal sarcoma
Adenofibroma with malignant transformation.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[specimen type], measuring [size] cm in greatest dimension
Diagnosis
[diagnosis name]
Classification
Classification: [classification system] [grade/type]
Histological Features
Shows [architectural pattern] with [nuclear features] and [mitotic activity]
Size and Extent
Size: [X] cm, extent: [local/regional/metastatic]
Margins
Margins are [involved/uninvolved] with closest margin [X] mm
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Lymph Node Status
Lymph nodes: [X] positive out of [X] examined
Special Studies
IHC: [marker]: [result]
Molecular: [test]: [result]
[other study]: [result]
Prognostic Factors
Prognostic factors: [list factors]
Final Diagnosis
Final diagnosis: [complete diagnosis]