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Primary peritoneal mesodermal adenosarcoma: report of a case and review of the literature
S Visvalingam1, R Jaworski, N Blumenthal
1Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales 2117.
Background:
Mesodermal (müllerian) adenosarcoma arising from the peritoneum is rare and is thought to arise from pluripotent mesothelial and mesenchymal cells of the pelvic cavity or from endometriotic deposits.
Case:
A case of primary peritoneal mesodermal adenosarcoma arising from the omentum is described. A 50-year-old woman presented with sudden abdominal distension. Initial laparotomy revealed a 13-kg mass arising from the omentum, which was determined from frozen and paraffin sections to be serous cystadenofibroma. The tumor recurred within 10 months and weighed 18 kg at a second laparotomy. Histopathology and review of the original tumor established the correct diagnosis of mesodermal adenosarcoma. The patient died from disseminated disease 6 months later.
Conclusion:
Adenosarcomas are difficult to differentiate from adenofibromas or endometriosis histologically because of the presence of large areas of low cellularity and infrequent mitotic figures. In such cases, stromal nuclear atypia and periglandular stromal cuffing are features that are diagnostic of adenosarcoma.
Insights
Primary peritoneal mesodermal adenosarcoma is a rare cancer. Diagnosis can be challenging, requiring careful histopathological review to distinguish it from benign conditions like adenofibroma.
Area of Science:
- Gynecologic Oncology
- Pathology
- Surgical Oncology
Background:
- Mesodermal (müllerian) adenosarcoma is a rare malignancy originating in the peritoneum.
- It is hypothesized to arise from pluripotent mesothelial and mesenchymal cells or endometriotic deposits.
Observation:
- A case of primary peritoneal mesodermal adenosarcoma arising from the omentum is presented.
- A 50-year-old woman initially presented with a large omental mass diagnosed as serous cystadenofibroma.
- The tumor recurred rapidly, and subsequent histopathology confirmed mesodermal adenosarcoma.
Findings:
- Mesodermal adenosarcomas present diagnostic challenges, often mimicking benign conditions like adenofibromas or endometriosis.
- Key diagnostic features include stromal nuclear atypia and periglandular stromal cuffing, especially when low cellularity and infrequent mitotic figures are present.
Implications:
- Accurate histopathological differentiation is crucial for appropriate patient management and prognosis.
- This case highlights the aggressive nature and diagnostic complexities of peritoneal mesodermal adenosarcoma.
- Early recognition of specific histological features is vital for correct diagnosis.
