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醫學五楊世慧詹舜文屠冠翔
2007/11/26 Breast Partial mastectomy
Invasive ductal carcinoma, Grade 3 , pT1bN1MxHER-2/Neu: 1+, negative
ER: 70% strongly positive
PR: 50% strongly postive
2010-7-20 Endometrium curettage
CD10
Uterus, endometrium, curettage
-----malignant Tumor, favor adenosarcoma with sarcomatous overgrowth
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
Immunohistochemistry
Epithelial component Keratin (+), ER (+), PR (+)
Mesenchymal component Cytoplasmic CD 10 (+) Nuclear ER (+), PR (+), WT-1 (+) Smooth muscle actin sometimes (+), desmin (+)
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
Malignant mixed mullerian tumor (MMMTs) Malignant epithelial and stromal components carcinomatous glandular component
Endometrial stromal sarcomas Malignant stromal component only no glandular component
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
2010/08/06
Uterus, Endometrium, total Hysterectomy Bilateral salpingooophorectomy Pelvic lymph node dissection Partial omentectomy
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
Sarcomatous overgrowth
Diagnosis
Uterine adenosarcoma with sarcomatous overgrowth
Myometrial invasion less than 25% of myometrial wall thickness
All else negative
2011 / 02/ 18 Intra-abdomen tumor resection with right hemicolectomy
Omentectomy
Gross: Multiple nodules measuring up to 1.5 x 1.5 x 1.0 cm
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