Mullerian adenosarcoma of the uterus: a rare neoplasm with a need for onco-fertility

A 23-year-old nulliparous woman re-presented with menorrhagia and intermenstrual bleeding two years after her first presentation with a similar history. Her initial symptoms were thought to be due to a removed fibroid polyp with histological confirmation. However at the second presentation, following a polypectomy, a diagnosis of low-grade mullerian adenocarcinoma of the uterine body was made. She had total abdominal hysterectomy and pelvic lymph node dissection, peritoneal fluid for cytology with conservation of ovaries to conserve her fertility. No residual tumour was found and lymph nodes were negative. She remains well under clinical surveillance in a multidisciplinary team setting. Different management options that have been used in past reports have been examined and also fertility sparing surgical techniques available for use in successful management of gynaecological cancer are also being explored to shed more light on potential surgical techniques that may be used in treating such rare tumours, particularly in women wishing to retain their fertility.