title: Cervical Mullerian adenosarcoma with heterologous sarcomatous overgrowth: a fourth case and review of literature.
abstract: BACKGROUND
  Uterine sarcomas are relatively rare tumors that account for approximately 1-3% of female genital tract malignancies and between 4-9% of uterine cancers. Less than 8% of all cases are Mullerian adenosarcoma, a distinctive uterine neoplasm characterized by a benign, but occasionally atypical, epithelial and a malignant, usually low-grade, stromal component, both of which should be integral and neoplastic constituents of the tumor. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very aggressive variant, associated with post-operative recurrence, metastases, even when diagnosed in early stage.
  
  
  METHODS
  We present a fourth MASO case derived from uterine cervix in a 72-year-old woman with metrorrhagia and a polypoid mass protruding through the cervical ostium. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic lymph node dissection, omental biopsy and appendectomy were performed. Surgery treatment was associated with adjuvant whole-pelvis radiation (45 Gy) and adjuvant chemotherapy (cisplatin/ifosfamide). After nine months of follow up, the patient was free of tumor.
  
  
  CONCLUSIONS
  The rarity of MASO of the cervix involves a management difficult. Most authors recommend total abdominal hysterectomy, usually accompanied by bilateral salpingo-oophorectomy. There is no common agreement on staging by lymphadenectomy during primary surgery and adjuvant chemo-radio therapy.
authors.affiliation: Department of Gynecological and Human Reproduction Sciences, University of Padua, via Giustiniani 3, 35128 Padua, Italy.
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.forename: Giorgia
authors.initials: G
authors.lastname: Guidi
authors.forename: Mario
authors.initials: M
authors.lastname: Rondinelli
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D018195:Adenosarcoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001062:Appendectomy; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007069:Ifosfamide / Q000008:administration & dosage; D008197:Lymph Node Excision; D018200:Mixed Tumor, Mullerian / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D009361:Neoplasm Invasiveness; D009852:Omentum / Q000473:pathology; D010052:Ovariectomy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D058994:Salpingectomy; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery
chemical_list: D002945:Cisplatin; D007069:Ifosfamide