1. 醫學五 楊世慧 詹舜文 屠冠翔 pathology

2. 2007/11/26Breast Partial mastectomy Invasive ductal carcinoma, Grade 3 , pT1bN1Mx HER-2/Neu: 1+, negative ER: 70% strongly positive PR: 50% strongly postive

3. 2010-7-20 Endometrium curettage

8. CD10

9. Uterus, endometrium, curettage -----malignant Tumor, favor adenosarcoma with sarcomatous overgrowth 2010/07/20

10. AdenosarcomaMicroscopic findings • Benign epithelial component: • Resembles inactive or proliferative endometrial epithelium • Malignant mesenchymal component: • Low-grade sarcoma • Resembles ESS, fibrosarcoma • Periglandular cuffs: hypercellularity • May contain heterologous elements

11. Immunohistochemistry • Epithelial component • Keratin (+), ER (+), PR (+) • Mesenchymal component • Cytoplasmic CD 10 (+) • Nuclear ER (+), PR (+), WT-1 (+) • Smooth muscle actin sometimes (+), desmin (+)

12. Differential Diagnosis • Adenofibromas • Benign epithelial and stromal components • paucicellular stroma , no periglandular cuffing, no stromal atypia • Benign endometrial polyp • Benign epithelial and stromal components • inactive glands, No periglandular cuffing , no stromal mitoses • Atypical polypoid adenomyoma • Atypical epithelial component and benign stromal component • cellular smooth muscle ,glandular component with squamous morules

13. Malignant mixed mullerian tumor (MMMTs) • Malignant epithelial and stromal components • carcinomatous glandular component • Endometrial stromal sarcomas • Malignantstromalcomponentonly • noglandularcomponent

14. Sarcomatous overgrowth • Uncommon variant • a benign glandular component • sarcomatous portion constituting more than 25% of the tumor • Higher grade and higher mitotic rate • High recurrence and mortality, comparable to carcinosarcoma

15. 2010/08/06 • Uterus, Endometrium, total Hysterectomy • Bilateral salpingooophorectomy • Pelvic lymph node dissection • Partial omentectomy

16. Gross Features • Endometrial polypoid tumor occupying the endometrial cavity and measuring 7.5 x 5 x 4.2 cm. Foci of necrosis and hemorrhage present. • No definite myometrial invasion grossly • Ovaries: no tumor • Omentum: 4.1 x 2.8 x 0.4 cm, no tumor

18. Sarcomatous overgrowth

20. Diagnosis • Uterine adenosarcoma with sarcomatous overgrowth • Myometrial invasion less than 25% of myometrial wall thickness • All else negative

21. 2011 / 02/ 18 Intra-abdomen tumor resection with right hemicolectomy

23. Omentectomy Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm

24. Reference • [1] Piura B, Rabinovich A, Meirrovitz M, Yanai I. Müllerian adenosarcoma of the uterus: case report and review of literature. Eur J Gynecol Oncol. 2000;21:387–390. • [2] American Cancer Society, Inc • [3] Atlas of Gynecologic Surgical Pathology • [4] Blaustein’s pathology of the female genital tract , fourth edition