Uterine adenosarcoma — master index¶
Last curated: 2026-10-31 · status: audited, with 2026-10-10, 2026-10-17, 2026-10-24 and 2026-10-31 literature sweeps that demoted edited pages to draft pending independent audit · 14 wiki pages · 73-paper live-resolved bibliography · 6 landmark notes · guidelines registry (10 documents) · statistics sheet · 6 organisation entries · 12 open questions + 1 answered question + 9 unconnected-dots junctions
The condition in five sentences. Uterine adenosarcoma is a rare biphasic Müllerian tumour with benign-appearing epithelium and a malignant stromal component, originally described in 1974; it can be mistaken preoperatively for a polyp or fibroid (Clement 1974, PMID 4371193; Clement 1990, PMID 2156771). Recurrence estimates are case-mix dependent: a narrative review states “at least 50%,” whereas Clement’s primary 100-case series reported 23 recurrences and Carroll’s stage I cohort reported 77% with sarcomatous overgrowth versus 22% without (Nathenson 2018, PMID 30169984; Clement 1990, PMID 2156771; Carroll 2014, PMID 25449308). Sarcomatous overgrowth has consistent multivariable support — in Carroll’s 74-patient single-institution cohort it separated median PFS of 29.4 from 105.9 months (HR 2.58, 95% CI 1.37–4.84) and OS of 55.4 from 112.4 months (HR 2.45, 95% CI 1.26–4.76) (PMID 25449308). Outside single institutions the evidence is registry-based and lacks central pathology review: NCDB counted adenosarcoma as 0.43% of uterine cancers; SEER 22 (2000–2019) counted 1,884 adenosarcomas (12.7% of 14,801 mesenchymal uterine sarcomas) with hysterectomy-corrected incidence 0.1 per 100,000 and 5-year relative survival 78.3% (75.7–80.6%); an older SEER extract of 544 found stage I 5-year survival 79% (75–84%) versus 48% (29–65%) for stage III, and a 797-patient SEER model reached c-index 0.774 without measuring overgrowth (Seagle 2016, PMID 27771166; Dave 2026, PMID 42951232; Arend 2010, PMID 20688363; Qu 2020, PMID 33680946). The safety problem is preoperative misidentification—occult uterine sarcoma occurred in 1 per 278 presumed-leiomyoma hysterectomies in a 34,728-procedure cohort, although that denominator is not adenosarcoma-specific—and the trial gap is no adenosarcoma-only randomised study or reported histology-specific randomised result (Raine-Bennett 2016, PMID 26646120).
Start here: overview.md. Research frontier: OPEN-QUESTIONS.md. Growth history: LOG.md.
The scoping decision that shapes this condition¶
A PubMed search for uterine adenosarcoma returns 263 records in total (re-checked 2026-10-31). Most of what exists is case reports and single-institution retrospective series. The largest multivariable institutional cohorts cited here are 74 (Carroll) and 165 (Nathenson); a 2026 seven-centre series adds n=43 without central review (Aytekin, PMID 42794871). The largest cited datasets remain 2,205 NCDB records and 1,884 SEER 22 adenosarcomas, both without central pathology review.
Two consequences, both deliberate:
The page list is 14, not the usual 19–20. Topics that earn a page in a common condition would be empty here.
The density target does not apply. See .density-exempt. Fourteen pages at 24 citations would need 336 citation-slots from a 258-record literature. A future deepen pass must not inflate it. Every claim is sourced and the grade of each source is visible on the page.
Seed-anchor corrections made at build. PMID 29441675 is Tate et al., not Tanaka. PMID 26646120 is Raine-Bennett et al., not Multinu; the Multinu occult-sarcoma paper is PMID 30447212 (2019).
Reading paths¶
- Clinical path — overview → pathology and diagnosis → sarcomatous overgrowth → staging and prognostic factors → surgical management → adjuvant and systemic therapy → guidelines
- Science path — pathology and diagnosis → sarcomatous overgrowth → molecular and genomic features → epidemiology and burden
- "What's unknown" path — OPEN-QUESTIONS.md → clinical-trials landscape → guidelines
- Safety / human path — red flags and safety concerns → clinical presentation and imaging → patient experience and advocacy → recurrence and surveillance
At a glance¶
| Layer | Built content |
|---|---|
| Canonical wiki pages | 14/14; pages edited 2026-10-10 are draft pending independent audit |
| Landmark notes | 6 |
| Guideline documents in registry | 10 |
| Patient-organisation entries | 6; SFA homepage 200, subtype/statistics pages 403; FWC homepage 403 on 2026-10-31 |
| Open questions | 12 open + OQ-12 answered (FUCHSia: one adenosarcoma partial responder) + 9 dots |
| Cited PubMed records | 73 live-resolved (66 from 2026-09-01 audit; PMIDs 42794871, 42706489, 38724237 added 2026-10-10; PMIDs 38113031, 42862247, 34271067 added 2026-10-17; PMID 42951232 added 2026-10-31) |
| Cited ClinicalTrials.gov records | All 14 IDs in condition markdown re-fetched 2026-10-31, including two background-only observational records; status, enrolment and results flags unchanged. EORTC results remain in EudraCT only |
| Total PubMed records for the condition | 263 (re-checked 2026-10-31) |
Wiki pages¶
| Section | Page | One-line scope | Status |
|---|---|---|---|
| Foundations | overview.md | What it is, why “low-grade” misleads, map | draft |
| Foundations | pathology-and-diagnosis.md | Biphasic architecture, adenofibroma line, polyp mimics | curated |
| Foundations | sarcomatous-overgrowth.md | 25% definition, frequency, survival split | draft |
| Foundations | epidemiology-and-burden.md | Shares, age, registry vs institutional mix | draft |
| Mechanism | molecular-and-genomic-features.md | MDM2/CDK4, TERT, BAP1, DICER1, TP53, SMARCA4 hybrids; not a test | draft |
| Clinical | clinical-presentation-and-imaging.md | Bleeding, polypoid mass, MRI catalogue | draft |
| Clinical | staging-and-prognostic-factors.md | FIGO 2009 IA/IB/IC, multivariable factors | draft |
| Clinical | surgical-management.md | Hysterectomy, BSO debate, lymphadenectomy, fertility | draft |
| Clinical | adjuvant-and-systemic-therapy.md | No reported histology-specific randomised effect; doxorubicin/ifosfamide at recurrence | draft |
| Clinical | recurrence-and-surveillance.md | Late local recurrence; lung among distant; no tested schedule | draft |
| Clinical | guidelines.md | ESGO 2024, French GSF 2023, GCIG 2014, FIGO 2009 | draft |
| Frontier | clinical-trials-landscape.md | Mixed-histology phase 3 and basket records; no histology-specific randomised result | draft |
| Human | red-flags-and-safety-concerns.md | Occult sarcoma, morcellation, missed SO, recurrent polyps | curated |
| Human | patient-experience-and-advocacy.md | Mixed-sarcoma HRQoL; no histology-specific qualitative cohort | draft |
Literature layer¶
| Artifact | What it holds |
|---|---|
| BIBLIOGRAPHY.md | Master bibliography, PMID-verified, tagged, cited-by-indexed |
| notes/ | 6 landmark notes (Clement 1989 SO, Clement 1990, Carroll 2014, Howitt 2015, Nathenson 2018 LVSI, Seagle 2016 NCDB) |
| guidelines/REGISTRY.md | 10 documents; disagreements and watch list |
| statistics/STATISTICS.md | Survival, recurrence, SO frequency, occult-sarcoma denominators; conflicts not averaged |
| patient-voice/ | Method + ethics, 6 organisation entries, 6 themes, annotated sources |
Curation state¶
All 14 pages passed independent audit by Codex on 2026-09-01. Subsequent literature sweeps (2026-10-10 Grok, 2026-10-17 Claude, 2026-10-24 Codex, 2026-10-31 Grok) added PMIDs and demoted edited pages to draft for later independent audit. The 2026-10-31 sweep added Dave 2026 (PMID 42951232) as the first retrieved hysterectomy-corrected adenosarcoma incidence rate. Claim corrections and residual access gaps are recorded in LOG.md.