Jafaru Abu1, David Ireland, Laurence Brown. 1. Department of Obstetrics and Gynaecology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
Abstract
BACKGROUND: Endometrial adenosarcoma is a rare tumor first described by Clement and Scully in 1974. It consists of benign or atypical neoplastic glands within a sarcomatous stroma and represents approximately 8% of all uterine sarcomas. Patients of a variety of ages are affected: the largest series reported 100 cases in patients aged 14-89 years, with the median age at presentation 58 years. Other case reports identified on a literature search also describe patients within this age range. The typical presentation is symptoms of abnormal vaginal bleeding. On examination, tissue protruding from the external cervical os is a common finding, with a smaller number of patients having an enlarged uterus or palpable pelvic mass. The standard management is total abdominal hysterectomy and bilateral salpingo-oophorectomy. However, difficulty arises when one is faced with this condition in a young nullipara wishing to preserve her fertility. CASE: Endometrial polyp adenosarcoma occurred in a 27-year-old, nulligravid woman who presented with intermenstrual and postcoital bleeding. She was managed conservatively but will require close followup subsequently. CONCLUSION: A clinical dilemma was encountered in the management of a young woman with endometrial polyp adenosarcoma because of the necessity to preserve her fertility.
BACKGROUND:Endometrial adenosarcoma is a rare tumor first described by Clement and Scully in 1974. It consists of benign or atypical neoplastic glands within a sarcomatous stroma and represents approximately 8% of all uterine sarcomas. Patients of a variety of ages are affected: the largest series reported 100 cases in patients aged 14-89 years, with the median age at presentation 58 years. Other case reports identified on a literature search also describe patients within this age range. The typical presentation is symptoms of abnormal vaginal bleeding. On examination, tissue protruding from the external cervical os is a common finding, with a smaller number of patients having an enlarged uterus or palpable pelvic mass. The standard management is total abdominal hysterectomy and bilateral salpingo-oophorectomy. However, difficulty arises when one is faced with this condition in a young nullipara wishing to preserve her fertility. CASE: Endometrial polyp adenosarcoma occurred in a 27-year-old, nulligravid woman who presented with intermenstrual and postcoital bleeding. She was managed conservatively but will require close followup subsequently. CONCLUSION: A clinical dilemma was encountered in the management of a young woman with endometrial polyp adenosarcoma because of the necessity to preserve her fertility.