title: Extragenital Müllerian adenosarcoma with pouch of Douglas location.
abstract: BACKGROUND
  Of all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Müllerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature.
  
  
  METHODS
  A 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Müllerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy.
  
  
  CONCLUSIONS
  The case of Müllerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst.
authors.affiliation: Department of Obstetrics, Gynecological and Perinatology Sciences, University of Parma, Italy. titosilvio.patrelli@gmail.com
authors.forename: Tito S
authors.initials: TS
authors.lastname: Patrelli
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Silini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Berretta
authors.forename: Laura
authors.initials: L
authors.lastname: Franchi
authors.forename: Elena
authors.initials: E
authors.lastname: Thai
authors.forename: Adolf
authors.initials: A
authors.lastname: Lukanovic
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Nardelli
authors.forename: Alberto Bacchi
authors.initials: AB
authors.lastname: Modena
mesh_terms: D018195:Adenosarcoma / Q000175:diagnosis / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D004312:Douglas' Pouch / Q000473:pathology* / Q000601:surgery; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery