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Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report

RATIONALE: Uterine adenosarcoma (UA) with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. Herein, wereported the case of a young patient with advanced uterine ASSO. PATIENTS CONCERNS: A 29-year-old woman with the diagnoses of endometrial polyp and adenomyosis underwent hysteroscopic...

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Autores principales: Wang, Bin, Yang, Hua-Di, Shi, Xin-He, Li, Hui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882639/
https://www.ncbi.nlm.nih.gov/pubmed/31764852
http://dx.doi.org/10.1097/MD.0000000000018119
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author Wang, Bin
Yang, Hua-Di
Shi, Xin-He
Li, Hui
author_facet Wang, Bin
Yang, Hua-Di
Shi, Xin-He
Li, Hui
author_sort Wang, Bin
collection PubMed
description RATIONALE: Uterine adenosarcoma (UA) with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. Herein, wereported the case of a young patient with advanced uterine ASSO. PATIENTS CONCERNS: A 29-year-old woman with the diagnoses of endometrial polyp and adenomyosis underwent hysteroscopic endometrial polypectomy for the giant endometrial polyp. Postoperative regular ultrasound scan indicated thickened endometriumand an ill-defined mass with continuous enlargement in the myometrium of the posterior wall of the uterus, which was considered as an adenomyoma. Two years after hysteroscopy, she was re-admitted due to lower abdominal distension and large pelvic mass. At that time, she had taken oral short-acting contraceptives for 2.5 years. DIAGNOSES: Magnetic resonance imaging (MRI) of the pelvis revealed an irregular mass with the size of 12∗56∗107 mm(3) in the right annex area, without distinct border with the rectum, moreover, an uneven intrauterine echo that has no obvious boundary with uterine wall. Right ovarian cancer and adenomyoma were initially considered. INTERVENTIONS: The patient received transperitoneal retroperitoneal pelvic combined with total viscera resection, including uterus, bilateral appendages and rectum, omentectomy, appendectomy, lymphadenectomy, and ileostomy. Postoperative pathology confirmed ASSO in the uterine cavity and muscular layer, the whole cervical duct and the right adnexal. She underwent 2 systemic chemotherapy sessions after the surgery. The chemotherapy regimen was ifosfamide 2.5 g day 1 to 3, with liposomal doxorubicin 40 mg day 1. OUTCOMES: The final diagnosis was uterine ASSO, International Federation of Gynecology and Obstetrics stage IVa. The patient has been following-up so far, with no progression. LESSONS: Review of the case indicated that history of long-term oral short-acting contraceptives and giant endometrial polyps may be the high-risk factors for UA. For patients with high-risk factors, the follow-up ultrasound scan should be more frequently conducted. Moreover, 3D-ultrasound, MRI and outpatient hysteroscopy are recommended for routine screening. Placement of levonorgestrel-releasing intra-uterine system after hysteroscopy may be an effective intervention for patients with a high risk of giant polyps. Cluster of Differentiation 10, Estrogen receptor, Progesterone receptor, and nuclear antigen may be predictors for prognosis and selection of individualized treatment program.
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spelling pubmed-68826392020-01-22 Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report Wang, Bin Yang, Hua-Di Shi, Xin-He Li, Hui Medicine (Baltimore) 5600 RATIONALE: Uterine adenosarcoma (UA) with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. Herein, wereported the case of a young patient with advanced uterine ASSO. PATIENTS CONCERNS: A 29-year-old woman with the diagnoses of endometrial polyp and adenomyosis underwent hysteroscopic endometrial polypectomy for the giant endometrial polyp. Postoperative regular ultrasound scan indicated thickened endometriumand an ill-defined mass with continuous enlargement in the myometrium of the posterior wall of the uterus, which was considered as an adenomyoma. Two years after hysteroscopy, she was re-admitted due to lower abdominal distension and large pelvic mass. At that time, she had taken oral short-acting contraceptives for 2.5 years. DIAGNOSES: Magnetic resonance imaging (MRI) of the pelvis revealed an irregular mass with the size of 12∗56∗107 mm(3) in the right annex area, without distinct border with the rectum, moreover, an uneven intrauterine echo that has no obvious boundary with uterine wall. Right ovarian cancer and adenomyoma were initially considered. INTERVENTIONS: The patient received transperitoneal retroperitoneal pelvic combined with total viscera resection, including uterus, bilateral appendages and rectum, omentectomy, appendectomy, lymphadenectomy, and ileostomy. Postoperative pathology confirmed ASSO in the uterine cavity and muscular layer, the whole cervical duct and the right adnexal. She underwent 2 systemic chemotherapy sessions after the surgery. The chemotherapy regimen was ifosfamide 2.5 g day 1 to 3, with liposomal doxorubicin 40 mg day 1. OUTCOMES: The final diagnosis was uterine ASSO, International Federation of Gynecology and Obstetrics stage IVa. The patient has been following-up so far, with no progression. LESSONS: Review of the case indicated that history of long-term oral short-acting contraceptives and giant endometrial polyps may be the high-risk factors for UA. For patients with high-risk factors, the follow-up ultrasound scan should be more frequently conducted. Moreover, 3D-ultrasound, MRI and outpatient hysteroscopy are recommended for routine screening. Placement of levonorgestrel-releasing intra-uterine system after hysteroscopy may be an effective intervention for patients with a high risk of giant polyps. Cluster of Differentiation 10, Estrogen receptor, Progesterone receptor, and nuclear antigen may be predictors for prognosis and selection of individualized treatment program. Wolters Kluwer Health 2019-11-22 /pmc/articles/PMC6882639/ /pubmed/31764852 http://dx.doi.org/10.1097/MD.0000000000018119 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 5600
Wang, Bin
Yang, Hua-Di
Shi, Xin-He
Li, Hui
Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report
title Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report
title_full Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report
title_fullStr Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report
title_full_unstemmed Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report
title_short Advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: A case report
title_sort advanced uterine adenosarcoma with sarcomatous overgrowth in a young woman: a case report
topic 5600
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882639/
https://www.ncbi.nlm.nih.gov/pubmed/31764852
http://dx.doi.org/10.1097/MD.0000000000018119
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