Adenosarcoma of the corpus uteri

Adenosarcoma of the corpus uteri, also known as Müllerian adenosarcoma of the uterus, is a rare mixed tumor of the uterine body composed of benign or atypical glandular (epithelial) elements combined with a malignant mesenchymal (stromal) component. This neoplasm primarily affects the uterine corpus and most commonly presents in postmenopausal women, although it can occur at any adult age. The tumor typically arises from the endometrium and may protrude into the uterine cavity as a polypoid mass. Key symptoms include abnormal uterine bleeding (most commonly postmenopausal bleeding), pelvic pain, and an enlarging pelvic or uterine mass. Some patients may present with tissue protruding through the cervical os. The tumor is generally considered low-grade malignant, but a subset of cases demonstrates sarcomatous overgrowth, which is associated with a significantly worse prognosis including higher rates of recurrence and metastasis. The primary treatment for adenosarcoma of the corpus uteri is surgical, typically involving total hysterectomy with bilateral salpingo-oophorectomy. The role of adjuvant therapy, including radiation therapy and chemotherapy, remains debated and is generally reserved for cases with high-risk features such as sarcomatous overgrowth, deep myometrial invasion, or advanced-stage disease. Recurrences tend to be local, occurring in the pelvis or vagina, though distant metastases can occur, particularly in cases with sarcomatous overgrowth. Long-term follow-up is recommended due to the risk of late recurrence. Prior pelvic radiation and long-term tamoxifen use have been identified as potential risk factors in some cases. Given its rarity, management is often guided by institutional experience and case series rather than large randomized trials.

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