Mullerian adenosarcoma of the uterus in a premenopausal woman: case report and literature review

Abstract

Introduction: Müllerian adenosarcoma is a rare biphasic uterine tumor, typically low-grade but with a worse prognosis when associated with sarcomatous overgrowth, deep myometrial invasion, or lymphovascular space invasion (LVSI). Despite being first described in 1974, reported cases remain limited.

Case Presentation: A 40-year-old premenopausal woman presented with abnormal uterine bleeding. Pelvic MRI showed a bulky uterus with a possible polypoidal growth or endometrial carcinoma. Endometrial biopsy suggested simple cystic hyperplasia. She underwent hysterectomy, and histopathology confirmed uterine adenosarcoma.

Discussion: Although rare, uterine adenosarcoma should be considered in patients with abnormal uterine bleeding and uterine masses. Its biphasic morphology and potential for sarcomatous overgrowth make diagnosis and prognosis difficult. Hysterectomy with bilateral salpingo-oophorectomy remains the standard treatment. The patient’s loss to follow-up after 24 weeks highlights the need for long-term monitoring.

Conclusion: Uterine adenosarcoma, though uncommon, must be included in the differential diagnosis of uterine growths. Early diagnosis and surgical management are vital, and further research on prognostic markers and adjuvant therapies is warranted.