Uterine Adenosarcoma Andadult Ovary Granulosa Tumor

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ISSN: 2320-5407 Int. J. Adv. Res.

9(03), 540-542

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/12613
DOI URL: http://dx.doi.org/10.21474/IJAR01/12613

RESEARCH ARTICLE
UTERINE ADENOSARCOMA ANDADULT OVARY GRANULOSA TUMOR

Hamza Messaoudi1, Yassine Bouhtouri, Khalid Guelzim, Moulay abdellah baba habib, Moulay El Mehdi el
Hassani1, Mohamed Amine Essaoudi2 and Jaouad Kouach1
1. Department of Gynecology and Obstetrics Mohammed V Military Hospital.
2. Anatomopatholog Department Mohammed V Military Hospital.
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Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Uterine adenosarcoma with an adult granulosa tumour is rarely
Received: 20 January 2021 described in the literature. The paucity of studies concerning this
Final Accepted: 24 February 2021 association makes it difficult both diagnostically and therapeutically.
Published: March 2021 We report a rare case of this association in a menopausal patient
Key words:-
admitted to our training course for post-menopausal metrorrhagia. The
Uterine adenosarcoma, Adult Granulosa evolution was favorable in this patient after radical treatment, which
Tumour, Post Menopausal metrorrhagia, was based on atotal hysterectomy with bilateral adnexectomy without
Polyploid hypertrophy adjuvant treatment.

Copy Right, IJAR, 2021,. All rights reserved.


……………………………………………………………………………………………………....
Introduction:-
Uterine adenosarcomas consist of a benign epithelial component and a malignant mesenchymal component [1,2].
There is minimal data to guide treatment decisions for this rare uterine sarcoma. Our report of a very rare case that
has never been reported before is a case that associates a uterine adenosarcoma and a tumor of the adult granulosa.

Granulosa cell tumors are neoplasms of the stromal cells of the ovarian sex cord and represent 2 to 5% of all ovarian
cancers [3-4]. almost all of them are capable of synthesizing estradiol. Prolonged exposure of the endometrium to
high levels of estrogen is responsible for pathological changes ranging from endometrial hyperplasia to endometrial
cancer [5].

Observation:-
She was a 76 year old patient, menopausal for 20 years, G9P9, with nine vaginal deliveries. For her medical history
she was hypertensive under medical treatment, and her surgical and family history was without particularity.

Symptomatology goes back to six months by the installation of post-menopausal metrorrhagia without any other
accompany sign, the whole evolving in a context of conservation of the general state, which motivated her
consultation in our training for care. At the general examination found a patient in good general condition,
hemodynamically stable (BP: 13/8cmhg), apyretic, the weight was 70kg for a height of 1.80m, the conjunctiva was
normally colored. The examination of thyroid and senological loge was without particularity, the abdominal
examination detected a localized sensitivity at the level of the left iliac fossa without any palpation mass. The
gynecological examination at the vulvoperineal inspection was without particularity, at the speculum the cervix was
aspirated with a healthy aspect without bleeding or leucorrhoea. At the vaginal touch the uterus was increased in size
through two fingers of the pubic symphysis and at the rectal touch the vaginal septum and the parameters were
without particularity The rest of the somatic examination was unremarkable.

Corresponding Author:- Hamza Messaoudi


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Address:- Department of Gynecology and Obstetrics Mohammed V Military Hospital.
.
ISSN: 2320-5407 Int. J. Adv. Res. 9(03), 540-542

Pelvic ultra sound showed an enlarged lobular uterus measuring 8/7cm with the presence of an intra cavitary
image, occupying the majority of the uterine cavity of heterogeneous hyperechogenic appearance measuring 7/5cm,
not vascularized on Doppler, the ovaries not seen, no effusion or latero-uterine mass, the douglas was empty.

A diagnostic hysteroscopywasperformed and revealed the presence of a richly vascular polyploid hypertrophy richly
vascularized, without any other notable sign, the biopsy was without particularity.The cervico vaginal smear showed
a very inflammatory and atrophic smear.
Mammography and breast ultrasound was unremarkable.

A total hysterectomy with bilateral adnexectomy was performed under general anesthesia, the incision of
pfannetial type , at the opening of the peritoneal cavity: the liver, the stomach, the omentum, the lumbo-aortic and
pelvic areas are all free of The uterus was increased in size and the ovaries without any particularity. A peritoneal
cytology was performed. The histopathological examination of the surgical specimen showed a morphological
aspect of adenosarcoma of the uterus (figure a) of 3 cm, long axis without myometrial invasion, and a tumor of the
adult granulosa of the leftovary (figure b) with capsular effraction. The adnexa, the uterine cervix and the vaginal
collars were free of tumor infiltration, and the peritoneal cytology was unremarkable.

Discussion:-
The association of a uterine adenosarcoma and a tumor of the adult granulosa of the ovary is very rare and has not
been reported. usually the tumor of the adult granulosa of the ovary are associated with uterine carcinosarcoma or
adenocarcinoma increased secretion of estrogen .Surgery is the basic treatment and consists of a total hysterectomy
with bilateral adnexectomy [6], which is sufficient, especially if the tumor is located in the uterus, allowing a 5-year
survival rate of almost 50%, where as pelvic lymphadenectomy remains controversial. Uterine adenosarcoma
represents 8% of uterine sarcomas [7,8]. Clement and Scully performed aliterature and found only a hundred or so
cases described in a usable way.cases described in a usable way. It is a postmenopausal cancer with an eage of 58
years. The clinicalsymptoms are veryvaried, dominated by metrorrhagia (71% of cases) [9] as in our case.tomake the
diagnosis, it is only after hysterectomy that the anatomopathological examination confirmed a positive diagnosis
which high lights the two malignant mesenchymal and benign epithelial contingents. Macroscopically, uterine
adenosarcoma appears as an enormous polypous, greyish or yellowish formation, usually originating in the
endometrium (87% of cases), sometimes in the cervix (9% of cases). Multicentric or extrauterine locations are
exceptional [7]. Numerous differential diagnoses can bediscussed, on the one hand mixed malignant Mullerian
tumors where both components are malignant: carcinosarcomas and mulleroblastomas with an unfavorable
prognosis [10] and on the other hand papillary adenofibroma characterized by a benign proliferation of both the
epithelial and conjunctive components.

Figure 1:- Histological microscopic section of a uterine adenosarcoma Standard stain ,hemalum eosin x25

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ISSN: 2320-5407 Int. J. Adv. Res. 9(03), 540-542

Figure 2:-Histological microscopic section of an adult granulosa tumor of the ovary Standard staining ,hemalun
eosin x 25.

Conclusion:-
The association of uterine adenosarcoma and a tumor of the granulosa of the ovary is very rare the diagnosis is
usually made in post surgery ,its treatment is total hysterectomy with bilateral adnexectomy and the prognosisis
favorable.

Conflicts of interest:
The authors declare no conflict of interest

References:-
[1] Clement PB, Scully RE. Mullerianadenosarcoma of the uterus. Hum Pathol. 1990;21:363–81.

[2] aku T, Silverberg SG, Major FJ, et al. Adenosarcoma of the uterus. Int J GynecolPathol.1992;11:75–88

[3] Evans AT, Gaffey TA, Malkasian GD Jr. Clinicopathologicreview of 118 granulosa and 82thecacelltumors.
ObstetGynecol.1980;55:231-238.

[4] Unkila-Kallio L, Tiitinen A, Wahlstrom T, et al. Reproductive features in women


developingovarian granulosa celltumour at a fertile age. Hum Reprod.2000;15: 589-593.

[5] Stenwig JT, HazekampJT ,Beecham JB. Granulosa celltumors of the ovary. Gynecol
Oncol.1979;7:136-152.

[6] Pectasides D, PectasidesE ,Psyrri A . Granulosa celltumorof the ovary. Cancer TreatRev.2008; 34: 1-12.

[7] Fatnassi R, Amri. L’adénosarcomeutérin à propos d’un cas. J GynecolObstet Biol Reprod.2005; 34:270-272.

[8] Piura B, Rabinovich A, MeirovitzM,et al . Mullerianadenosarcoma of the uterus. Eur J


GynaecolOncol.2000;21: 387-390.

[9] H Farhat M, Hobeika E.M, MoumnehG,et al. Uterine Mullerian adenosarcomawithSarcomatousovergrowth


fatalrecurrencewithintwoweeks of diagnosis. Journal of MedicalCase Reports.2007;1:103.

[10] Kabwa L, Mattei JP, Eloit S, et al. Un casd’adénosarcomeutérin et vaginal dansUncontexte de


prolapsusgénitalremanié. J Chir .1997;134:80-5.

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