Abstract
Mullerian adenosarcoma following tamoxifen therapy is a rare condition. Our aim was to report the youngest patient in the literature with uterine mullerian adenosarcoma who was undergoing tamoxifen therapy for breast cancer. A premenopausal woman aged 38 years who was undergoing tamoxifen therapy for breast cancer, was admitted with symptoms of lower abdominal pain and irregular vaginal bleeding and malodorous vaginal discharge that had continued for at least 6 months. A pelvic examination revealed a large and malodorous polypoid mass protruding through the cervix and an enlarged uterus. A biopsy from the protruding polypoid mass was reported as a large area of necrosis with neoplastic mesenchymal cells. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oopherectomy, pelvic-paraaortic lymph node dissection, and omentectomie. The histologic diagnosis was Mullerian adenosarcoma. As a result, she was discharged to the oncology department. The woman is alive and her chemoradiotherapy treatment is ongoing.The role of tamoxifen therapy in the development of endometrial neoplasms remains unclear, but all cases of endometrial thickening and vaginal bleeding must be investigated for Mullerian adenosarcoma in tamoxifen users.
Highlights
Mullerian adenosarcoma is an uncommon variant of mullerian mixed tumor of the uterus
The role of tamoxifen therapy in the development of endometrial neoplasms remains unclear, but all cases of endometrial thickening and vaginal bleeding must be investigated for Mullerian adenosarcoma in tamoxifen users
Despite its therapeutic effect on breast carcinoma, its estrogenic effect on the endometrium may be complicated by a number of endometrial lesions such as hyperplasia, polyps, endometriosis, carcinoma, and less frequently mesenchymal and mixed epithelial-mesenchymal uterine tumors such as adenomyoma, leiomyoma, and adenosarcoma[3]
Summary
A multiparous woman aged 38 years was admitted to our hospital with symptoms of lower abdominal pain and irregular vaginal bleeding and malodorous vaginal discharge that had continued for at least 6 months She had a history of breast cancer. Magnetic resonance images showed that a 192x100 mm uterus and a 75x65 mm solid heterogeneous mass filled the endometrial cavity without signs of invasion to surrounding tissues (Figure 1a). The mesenchymal component consisted of low-grade sarcoma, which was typically more cellular around the glands resulting in periglandular cuffs (Figure 2a) In these cellular areas, there was a maximum of 9 mitotic figures/10 HPF; the sarcomatous cells appeared to contain focal atypia and pleomorphic endometrial stromal cells or fibroblasts (Figure 2b). She is still alive with vertebral bone metastasis
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