28. Mullerian adenosarcoma: A rare endocervical polyp in a 14-year-old

Abstract

Case report A 14-year-old girl presented with a 3-month history of vaginal discharge and a protruding vaginal mass. MRI revealed a cervical mass distending the upper vagina. A soft pedunculated endocervical polyp (5×3 cm) was removed piecemeal. Histologically, scattered glands lined by bland endometrioid and endocervical epithelia were surrounded by a variably cellular stroma displaying prominent periglandular cuffing, subepithelial condensation, mild stromal nuclear atypia and mitotic activity. No sarcomatous overgrowth or heterologous elements were identified. Immunostaining showed patchy reactivity for CD10, ER and PR, and negative staining for desmin and myogenin. The diagnosis of Mullerian adenosarcoma was made. Discussion Mullerian adenosarcoma arising in the cervix is much less common than those in the uterine corpus. The mean age of patients (37 years) is significantly younger than women with adenosarcoma of the corpus, the majority of whom are postmenopausal. To our knowledge, cervical adenosarcoma has been reported in 13 patients below 20 years of age. In those 5 patients in whom hysterectomy was avoided, and local conservative treatment preferred, the tumour subsequently recurred in the endometrium in four. Thus, optimal therapy for these very young patients poses a significant clinical dilemma. In our case, the decision has been for conservative management with regular watchful follow up. Clinically and histologically, adenosarcoma can be confused with other lesions and may not be correctly diagnosed until recurrence occurs. The histological features (e.g., stromal hypercellulairty, periglandular cuffing) may be subtle and patchy. Extensive sampling and attention to subtle histological changes should lead to correct diagnosis. We report a case of Mullerian adenosarcoma presented as an endocervical polyp in a 14-year-old to raise an awareness of this rare paediatric tumour.