Unusual and rapid amniotic fluid cell growth

Abstract

The majority of malignant neoplasms arising in endometriosis have been adenocarcinomas.’ In their recent review, Mostoufizadeh and Scully’ recalled five cases of malignant mixed miillerian tumor and 19 cases of stromal sarcoma originating in gonadal and extragonadal endometriosis. Even rarer is the phenomenon of massive polypoid endometriosis in which the histologic features of conventional endometriosis persist despite the gross appearance which simulates a malignant neoplasm.’ The present case is particularly unique in that a sarcoma developed within extensive endometriosis and that it did so despite apparent obliteration of ovarian function by irradiation. In view of the course of events, the question arises whether the original lesion was indeed histologically benign endometriosis and not adenosarcoma. The original sections contained normal-appearing proliferative-type endometrial glands with focal cystic hyperplasia. The endometrial stroma was unremarkable in most areas with the exception of focal hypercellular and mitotically active regions. This illdefined phenomenon of “stromal hyperplasia” has previously been reported in endometrial curettings from a patient who subsequently developed miillerian adenosarcoma of the uterus.3 Whether the stromal proliferation observed in this case placed the patient at greater risk for subsequent stromal sarcoma is a matter of conjecture inasmuch as the degree of mitotic activity and cellular pleomorphism was much less than in the sarcoma and was consistent with that found in proliferative endometrium. In addition, a classic pattern of neoplastic stromal growth such as stromal nodules or endolymphatic stromal myosis was not present. Irradiation of the ovaries as primary therapy for endometriosis is not generally recommended and was performed in this case only when surgical castration could not be carried out and hormonal therapy was Fig. 3. The sarcoma was composed of oval to spindle-shaped neoplastic mesenchymal cells. They were arranged randomly and in a plexiform pattern in a collagen matrix.