Mullerian Adenosarcoma of the Endometrium in a 19-Year-Old Girl: Case Report and a Literature Review

Case Report

Austin Crit Care Case Rep. 2021; 5(1): 1022.

Mullerian Adenosarcoma of the Endometrium in a 19-Year-Old Girl: Case Report and a Literature Review

Miyoshi A¹, Ueda Y¹*, Sato K² and Kimura T¹

1Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Japan

2Department of Pathology, Osaka University Graduate School of Medicine, Japan

*Corresponding author: Yutaka Ueda, Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka Suita, Osaka 567-0871, Japan

Received: January 05, 2020; Accepted: February 05, 2021; Published: February 12, 2021

Abstract

Mullerian adenosarcoma of the endometrium in adolescent girls is extremely rare, with only fifteen cases under 20 years old having been reported to date. We describe here a new case of adolescent Mullerian adenosarcoma and provide an updated review of the previous literature on such rare tumors. Our 19-year-old case presented with a six-month history of prolonged menstruation. She had not yet had any sexual relationship. On gross examination, a fragile mass was seen in her vagina that bled easily. A 4.0×2.0 cm mass was visualized with Magnetic Resonance Imaging (MRI). The tumor seemed to slightly invade the myometrium of the uterine corpus. Transvaginal ultrasound sonography confirmed the presence of a 4.0 cm mass located in the cervix and vagina. The tumor biopsy was diagnosed as a Mullerian adenosarcoma of the endometrium. We performed a Total Abdominal Hysterectomy (TAH) and Bilateral Salpingectomy (BS). The post-surgical specimen was diagnosed as a pT1aNXM0 Mullerian adenosarcoma of the endometrium. The patient did not require adjuvant chemotherapy. She has been monitored every 3 months and has been without recurrence now for 28 months.

Keywords: Mullerian Adenosarcoma; Endometrium; Adolescent Girl; Fertility

Introduction

First reported by Clement and Scully in 1974 [1], Mullerian adenosarcoma was described as a distinct histologic type of the mixed mesodermal tumors. This rare new tumor was considered to be a mesodermal tumor consisting of benign glandular epithelial cells and malignant mesenchymal cells, it now represents nearly 8% of all uterine sarcomas. Mullerian adenosarcomas occur most frequently in postmenopausal women; their occurrence in adolescent girls is quite rare. In adolescent girls, there are a few reports of Mullerian adenosarcoma of the cervix but Mullerian adenosarcomas of the endometrium are extremely rare. To our knowledge, only 15 cases under 20 years old occurrences [2-16] have been reported since the time of Clement and Scully’s first definition of it; these reports are summarized in (Table 1). We report here on a new case of Mullerian adenosarcoma of the endometrium in a 19-year-old girl, and we provide an updated literature review concerning all previous such cases.

Case Presentation

A 19-year-old girl presented to her local hospital with a six-month history of prolonged menstruation. She denied having had a sexual relationship. On gross examination, an easily-bleeding fragile mass was seen in her vagina. The patient’s CA125, CA19-9, and CEA serum levels were normal. A 4.0×2.0 cm mass attached to endometrium was seen by Magnetic Resonance Imaging (MRI). The tumor seemed to slightly invade the myometrium of the uterus corpus (Figure 1). A transvaginal ultrasound and biopsy were performed under anesthesia. Sonography confirmed the presence of a 4.0 cm mass located in the cervix and vagina but it could not confirm its exact origination. It was difficult to see the stem of the mass and the cervix because of the persistent bleeding.