Unveiling the intriguing grape‐like mass: Uterine cervical adenosarcoma

Abstract

Key Clinical Message

Adenosarcoma of the uterine cervix should be considered in the evaluation of post‐menopausal bleeding, as it can be a potential underlying cause. Timely diagnosis and appropriate management are essential to optimize patient outcomes.

Abstract

Adenosarcoma is a biphasic neoplasm comprising both a benign epithelial component and a typically low‐grade sarcomatous stromal component. Adenosarcoma mainly affects the endometrium (71%), with a lesser incidence in the cervix (2%). Herein, the authors report a case of adenosarcoma of the uterine cervix with distinct gross features.

(A) Anterior view of the cervical mass displaying a distinctive cluster‐of‐grapes‐like morphology. (B) Distinct cluster of grapes‐like morphology observed in the cervical mass (posterior view). (C) Histological evaluation of the cervical mass revealed a phyllodes‐like growth pattern with characteristic subepithelial neoplastic stromal condensation (cambium layer), (Hematoxylin and eosin, magnification ×40). (D) Intraglandular projections and leaf‐like (phyllodes‐like) architecture, (Hematoxylin and eosin, magnification ×100).

1. CASE IMAGE

A 53‐year‐old woman with an unremarkable medical history presented with a 5‐month history of post‐menopausal uterine bleeding. During the physical examination, the patient was in good general condition. The abdominal examination showed no abnormalities. The laboratory tests yielded normal results. Speculum examination revealed a polypoid budding lesion of the uterine cervix, which was biopsied. Histopathological examination of the biopsy samples confirmed a benign fibrous polyp. Cervical cytology results were negative for malignant cells. Pelvic ultrasound showed a uterus of normal size and echotexture, with no fluid collection. Hysteroscopy with resection of the cervical mass originating from the lower lip of the cervix was planned for this patient. The surgical procedure involved the removal of a large polypoid mass that originated from the endocervix. The mass, which was not attached to any neighboring structures, was successfully excised along with its stalk. Upon gross examination, the uterine cervical mass exhibited a characteristic appearance reminiscent of a cluster of grapes. It measured 7 × 5 × 3 cm and weighed 69 g (Figure 1A,B). Histologically, the findings included a phyllodes‐like architectural pattern (Figure 1C,D). The stromal component exhibited a fibroblastic morphology with focal myxoid (Figure 2A) and edematous areas (Figure 2B). Heterologous stromal elements such as fetal‐type cartilage (Figure 2C,D) and adipocytes (Figure 3A) were observed. The benign glands were lined by endocervical‐type epithelium (Figure 3B), with areas of squamous differentiation and mucinous metaplasia (Figure 3C). Mitotic figures were inferior to 2 mitoses per 10 high‐power fields (Figure 3D). The stromal component of the tumor showed strong positive immunostaining for CD10 (Figure 4A,B), but tested negative for desmin (Figure 4C) and myogenin (Figure 4D) immunostaining. The final pathological diagnosis was uterine cervical adenosarcoma with heterologous elements. The patient underwent an uneventful total abdominal hysterectomy with bilateral salpingo‐oophorectomy and pelvic lymph node dissection. Currently, the patient is under regular follow‐up.

FIGURE 1.

(A) Anterior view of the cervical mass displaying a distinctive cluster‐of‐grapes‐like morphology. (B) Distinct cluster of grapes‐like morphology observed in the cervical mass (posterior view). (C) Histological evaluation of the cervical mass revealed a phyllodes‐like growth pattern with characteristic subepithelial neoplastic stromal condensation (cambium layer), (Hematoxylin and eosin, magnification ×40). (D) Intraglandular projections and leaf‐like (phyllodes‐like) architecture, (Hematoxylin and eosin, magnification ×100).

FIGURE 2.

(A) Histologically, the stromal component displayed focal areas of myxoid appearance (Hematoxylin and eosin, magnification ×100). (B) Histologically, the stromal component exhibited localized regions with an edematous appearance, (Hematoxylin and eosin, magnification ×100). (C) Small islands of heterologous benign fetal cartilage (blue asterisk), (Hematoxylin and eosin, magnification ×100). (D) Small islands of heterologous benign fetal cartilage (blue asterisk), (Hematoxylin and eosin, magnification ×400).

FIGURE 3.

(A) Image depicts the presence of heterologous stromal elements, specifically adipocytes (Hematoxylin and eosin, magnification ×400). (B) The histological image illustrates periglandular cellular stroma, forming a distinctive cambium‐like layer surrounding the glands (Hematoxylin and eosin, magnification ×100). (C) Histopathological examination showing metaplastic mucinous epithelium lining the glands, characterized by the absence of cellular atypia or mitotic figures (Hematoxylin and eosin, magnification ×400). (D) The histological image reveals a stromal component composed of spindle cells arranged in sheets, showing mild atypia and a low mitotic activity (Hematoxylin and eosin, magnification ×400).

FIGURE 4.

(A) Immunohistochemical analysis demonstrates intense positive staining for CD10 in the tumor cells (Immunohistochemistry, magnification ×100). (B) At high magnification, the tumor cells demonstrate intense expression of CD10 (Immunohistochemistry, magnification ×400). (C) Immunohistochemical analysis reveals negative staining of tumor cells for desmin (Immunohistochemistry, magnification ×100). (D) Immunohistochemical analysis shows negative staining of tumor cells for myogenin (Immunohistochemistry, magnification ×400).

2. DISCUSSION

Adenosarcoma is a rare tumor, representing only 0.16% of all cervical cancers and around 10% of adenosarcomas in the female genital tract. ¹ Cervical adenosarcoma primarily affects young patients, with a median age at presentation of 37–39 years. ¹ , ² Typical presentations of cervical adenosarcoma include abnormal vaginal bleeding (most common), pelvic pain, abdominal mass, and vaginal discharge. The standard and effective treatment for the majority of adenosarcoma cases is hysterectomy with bilateral salpingo‐oophorectomy. Radiation therapy is considered for patients with advanced stages (FIGO stage II or higher) or in cases of recurrence. ¹ , ² , ³ Fertility‐sparing surgery using cervical conization may be an option in select cases. Cervical adenosarcomas typically have a favorable prognosis, with most cases diagnosed at FIGO stage I and a 5‐year overall survival rate of 63%–84%. ¹ , ² , ³ Positive prognostic factors include low‐grade histology, no myometrial invasion or sarcomatous overgrowth, while the presence of heterologous elements indicates a worse outcome. ² The differential diagnoses for adenosarcoma encompass adenofibroma, carcinosarcoma, endocervical polyp, endometrial stromal sarcoma, and rhabdomyosarcoma. High mitotic activity (>1 per 10 high‐power fields) is a reliable criterion to distinguish adenosarcoma from adenofibroma.

AUTHOR CONTRIBUTIONS

Faten Limaiem: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; resources; supervision; validation; visualization; writing – original draft; writing – review and editing. Nizar Ben Aissia: Formal analysis; investigation; resources; software; supervision; validation; visualization.

FUNDING INFORMATION

We did not receive funding for this article.

CONFLICT OF INTEREST STATEMENT

None declared.

ETHICS STATEMENT

All procedures performed were in accordance with the ethical standards. The examination was made in accordance with the approved principles.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

Limaiem F, Ben Aissia N. Unveiling the intriguing grape‐like mass: Uterine cervical adenosarcoma. Clin Case Rep. 2024;12:e8683. doi: 10.1002/ccr3.8683

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.