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Curation log — uterine adenosarcoma

Newest entries first. Every content-changing session appends an entry: date, what changed, what was searched, follow-ups for next time. See CLAUDE.md.

2026-10-31 — Periodic literature sweep (since 2026-10-24; author: Grok)

Sources actually queried. PubMed E-utilities esearch/esummary/efetch, inclusive 2026/10/24–2026/10/31 on publication (pdat) and entry (edat) dates. Thirteen topic searches: all adenosarcoma; uterine adenosarcoma; pathology/diagnosis; SO/staging/prognosis; molecular/SMARCA4; epidemiology/registry/burden; imaging/presentation; surgery/fertility/morcellation; systemic/adjuvant/trials; recurrence/surveillance; guidelines; patient experience; broad uterine sarcoma. All-time uterine adenosarcoma is 263 (was 262). The union of windowed searches returned 11 PMIDs, of which two were adenosarcoma-titled: PMID 42951232 (SEER 22 histotype incidence/survival) and PMID 42951389 (unusual presentations and mimics review). The other nine were other uterine-sarcoma histologies or class-level papers and were not added.

Cochrane and Europe PMC. Twelve per-topic PubMed CDSR searches (windowed) returned 0 each. "Cochrane Database Syst Rev"[jour] AND adenosarcoma remains 0 all-time. That is a PubMed-indexed-CDSR finding; cochranelibrary.com and CENTRAL were not queried (HTTP 403 per SOURCES.md). Europe PMC REST was queried per topic with FIRST_PDATE or CREATION_DATE in the same window. Broad adenosarcoma FIRST_PDATE 1 (Dave, PMID 42951232, isOpenAccess=N, inPMC=N); CREATION_DATE 6, of which the adenosarcoma-specific records were Dave and Dinh/Chapel (PMID 42951389, also isOpenAccess=N, inPMC=N) plus previously triaged PMID 42914689. Europe PMC CDSR window 0; adenosarcoma preprints in-window 0 (15 all-time, none new). PMID 42862247 is now indexed there and remains isOpenAccess=N, inPMC=N. OpenAlex window searches for uterine adenosarcoma and adenosarcoma returned 0. DOAJ adenosarcoma 129 total; newest created 2026-09-27, already triaged. Unpaywall skipped because LIFEBANK_CONTACT_EMAIL is unset. SciELO and LILACS could not be searched (HTTP 403); no regional-literature absence is asserted.

Trials, including non-US sources. ClinicalTrials.gov v2: all 14 NCT IDs in the condition markdown re-fetched. Status, enrolment, results flag and last-update date are unchanged from 2026-10-24. Keyword counts remain 5 (uterine adenosarcoma) and 7 (adenosarcoma); all 292 uterine sarcoma records were scanned and yielded the same nine adenosarcoma string matches, no additional eligibility-named protocol. Elacestrant NCT07467772 remains recruiting, estimated n=30, last update 2026-05-22; NCT00162721 remains UNKNOWN, estimated n=270, no posted results; NCT01979393 remains completed actual n=58, hasResults=false. EudraCT adenosarcoma returned the same five protocols (FUCHSia 2017-005018-76, EORTC 62113 2013-000762-11, plus three paediatric). The EORTC results page still reports 30 vs 29 analysed at the primary endpoint and still has no histology-specific baseline counts; adenosarcoma appears only as an eligibility-amendment mention (HGAS). No EORTC 62113 primary publication was found in a targeted PubMed search this session. ISRCTN returned a cookie/JavaScript holding page. ChiCTR search was not a usable result set (404). CTRI timed out. WHO ICTRP portal HTTP 200 but JS-driven; programmatic search not counted. Named EU registry used directly.

What survived triage.

  1. Dave 2026, PMID 42951232 (abstract read; AJOG full text not served — Europe PMC OA=N / not in PMC; publisher page HTTP 403). SEER 22, 2000–2019, n=14,801 microscopically confirmed uterine sarcomas, age ≥20. Adenosarcoma 12.7% (n=1,884); LMS 53.3% (7,883); ESS 26.7% (3,948); sarcoma NOS 5.7%; undifferentiated 1.7%. Hysterectomy-corrected incidence: adenosarcoma 0.1 per 100,000, LMS 0.6, ESS 0.3. Five-year relative survival for adenosarcoma 78.3% (75.7–80.6%). No central pathology review. Carcinosarcoma is not among the listed histotypes, so 12.7% is not comparable to Arend’s 10% or the ~5% review synthesis. Abstract-stated NHB highest incidence across all listed histotypes, including adenosarcoma; histotype-specific rates by race were not in the abstract. This is the first retrieved population incidence per 100,000 for this histology. Not a landmark note (registry epidemiology, no SO, abstract-only).
  2. Dinh and Chapel 2026, PMID 42951389 (abstract read; Surgical Pathology Clinics full text not served). Dedicated review of unusual presentations and histologic mimics. The abstract restates known biphasic morphology and adverse features (SO, invasion, LVSI, heterologous elements, marked atypia) without new numbers. Not added to the cited set.

Not added (honest empty remainder). Occult-sarcoma narrative review PMID 42942324 (class-level 0.1–0.4%, not adenosarcoma-specific). Carcinosarcoma case PMID 42957266. LMS/BCOR/KAT6B/RMS/methylation/pharmacogenomic papers in the broad uterine-sarcoma window. No new Cochrane review. No new society guideline. No new adenosarcoma-specific patient-organisation material. No new qualitative study.

Guidelines / organisations / statistics portals. ESGO pocket PDF still HTTP 200; ESGO guidelines page 200 and JS-rendered with no adenosarcoma in static HTML. NCCN guidelines-detail page still lists Uterine Neoplasms Version 3.2026; parent PDF not independently retrieved. ACS page cites NCCN Version 2.2026 (14 November 2025) — a stale public citation, not a new guideline. NCI health-professional PDQ still names adenosarcoma; content Updated remains 2024-12-17 (dcterms.issued 2026-10-28 is a page-issue stamp). FWC homepage now HTTP 403 (was 200 on 2026-10-10). SFA homepage 200; subtype and statistics pages still 403. Sarcoma UK and Sarcoma Alliance 200. SEER data landing pages 200 without an adenosarcoma-specific table. No new burden statistic beyond Dave.

Retraction checks. PMIDs 42951232 and 42951389: PubMed publication types are Journal Article / Review; no Retracted Publication or Expression of Concern. Crossref updated-by empty for DOIs 10.1016/j.ajog.2026.10.034 and 10.1016/j.path.2026.06.009. Trozzi DOI 10.1136/ijgc-2023-005229 rechecked, updated-by empty.

Files changed. Wiki: overview.md, epidemiology-and-burden.md — both remain status: draft, last-curated: 2026-10-31. Literature: BIBLIOGRAPHY.md (72→73 PMIDs), statistics/STATISTICS.md, patient-voice/organizations.md. OPEN-QUESTIONS.md: OQ-11 sharpened with Dave’s rate; OQ-6 count 262→263. INDEX.md reconciled. Search manifest: 2026-10-31.json. No landmark note. No other condition changed; no publishing or git commands run.

Next sweep. Retrieve Dave 2026 full text/tables for adenosarcoma-specific stage and race-stratified rates, and for whether SO is captured (it will not be in SEER, but confirm). Follow EORTC 62113 histology counts/outcomes and 58-versus-59 reconciliation, including any primary publication. Continue NCT07467772 accrual/results and NCT00162721. Retry current NCCN parent algorithm and SFA child pages; FWC if it becomes fetchable. Watch for a pathology-reviewed SO/LVSI pooled model (OQ-1) and a SMARCA4/BRG1 frequency series (OQ-4). Another isolated mimic case or restating review is not a landmark. The independent auditor should check Dave’s abstract numbers (1,884 / 12.7% / 0.1 per 100,000 / 78.3%) against the AJOG full text if it is served.

2026-10-24 — Periodic literature sweep (since 2026-10-17; author: Codex)

Sources actually queried. PubMed E-utilities esearch and efetch, inclusive 2026/10/17–2026/10/24 on publication (pdat) and entry (edat) dates. Thirteen topic searches: all adenosarcoma; uterine adenosarcoma; pathology/diagnosis; SO/staging/prognosis; molecular/SMARCA4; epidemiology/registry/burden; imaging/presentation; surgery/fertility/morcellation; systemic/adjuvant/trials; recurrence/surveillance; guidelines; patient experience; broad uterine sarcoma. All-time uterine adenosarcoma remains 262. The union of windowed searches returned four records: PMID 42914689 (benign-polyp mimic case), 42909529 (necrotic leiomyoma imaging case), 42894409 (ESS cohort) and 42890541 (undifferentiated uterine sarcoma case). None warrants a new bibliography entry or wiki synthesis. No new paper survived triage; the retained findings are follow-up source recoveries and EU registry results.

Cochrane and Europe PMC. Twelve per-topic PubMed CDSR searches (all-condition plus the major topic expansions; publication OR entry window) returned 0 each. Europe PMC REST was queried per topic with FIRST_PDATE OR CREATION_DATE in the same window, with core metadata/full-text availability. Its broad adenosarcoma search returned 4, including the previously added SMARCA4 case (PMID 42862247), now indexed there but still isOpenAccess=N, inPMC=N; other matches were incidental mentions in papers of other scope. The corrected quoted singular/plural uterine-sarcoma query returned 10. An initial malformed plural query was excluded and rerun; the manifest identifies it explicitly. Europe PMC CDSR broad-window query 0; adenosarcoma preprints 0. No non-PMID journal article was added. Cochrane Library/CENTRAL was not queried (HTTP 403 documented in SOURCES.md). SciELO and LILACS could not be searched (HTTP 403 per repository guidance); no regional-literature absence is asserted. Unpaywall skipped because LIFEBANK_CONTACT_EMAIL is unset; no personal email used. OpenAlex and DOAJ were not queried.

Trials, including non-US sources. ClinicalTrials.gov v2: all 14 NCT IDs found in the condition markdown re-fetched (12 from the previous manifest plus the two background-only observational records). All 12 baseline records have unchanged status, enrolment, results flag and last-update date. Keyword counts remain 5 (uterine adenosarcoma) and 7 (adenosarcoma); all 292 uterine sarcoma records were scanned (was 291), yielding the same nine adenosarcoma string matches and no additional eligibility-named protocol. Elacestrant NCT07467772 remains recruiting, estimated n=30; NCT00162721 remains unknown, estimated n=270, without posted results. EudraCT adenosarcoma returned five protocols, including FUCHSia and EORTC 62113; the other three concern paediatric malignancies. ISRCTN returned a cookie/JavaScript holding page, not usable results. WHO ICTRP was not queried; the named EU registry was used directly.

What changed the knowledge base.

  • OQ-12 answered: the EudraCT FUCHSia publication attachment is the full Trozzi 2024 paper, not merely an abstract (PMID 38724237). Table 1 (PDF p4, rendered and inspected) identifies one adenosarcoma among four uterine sarcomas; the Efficacy section (p3) identifies that patient as the RECIST partial responder with low-grade adenosarcoma without SO. This is n=1, not a reliable histology-specific response-rate estimate. The paper reports 16 enrolled/15 analysed versus ClinicalTrials.gov n=17; Table 1 lists 2 ESS + 1 unknown whereas the narrative describes 3 low-grade ESS. These discrepancies are preserved, not reconciled by assumption. The attachment was first posted 2024-06-09: newly accessed today, not a new publication. The manifest records the short source quotation and table locations.
  • EORTC 62113 EU results found: EudraCT 2013-000762-11 final results, first posted 2026-06-18, report 59 randomised (30 cabozantinib / 29 placebo), versus ClinicalTrials.gov NCT01979393 actual 58, hasResults=false. The EU primary-endpoint table reports 13 vs 12 alive without progression at four months, one-sided Fisher p=0.544. The retrieved baseline tables give age, sex and performance status, without histology counts; no adenosarcoma treatment effect is inferred. Counts remain side by side. This is older, newly accessed registry evidence, not an in-window result posting.
  • Access notes corrected: ESGO’s 2025 pocket PDF now returns 200; cover/source page identifies it as based on the 2024 guideline, not a 2026 replacement. The ESGO search page is JS-rendered without usable update metadata. NCCN detail-page attempts returned 404 and the official parent PDF 403, so the current version could not be re-established. NCI PDQ remains dated 2024-12-17. FWC, Sarcoma UK and Sarcoma Alliance homepages were retrieved; SFA homepage now returns 200 and provides education/support/patient-story links, while its subtype and 2026-statistics pages still return 403. No new adenosarcoma-specific patient material was retained. SEER releases page and Sarcoma UK incidence table were checked: the latter is last reviewed May 2023, covers all-site adenosarcoma rather than a uterine-specific denominator, and was not added as a new burden estimate. No new guideline or burden statistic survived the sources checked.

Retraction checks. Trozzi (PMID 38724237), the EORTC protocol (PMID 32546554), ESGO guideline (PMID 39322612), and the triaged benign-polyp case (PMID 42914689) were re-fetched through PubMed E-utilities: no Retracted Publication or Expression of Concern types; no comments/corrections flags. Crossref DOI lookups gave empty updated-by for all four. No new bibliography record and no landmark note.

Files changed. Wiki: clinical-trials-landscape, adjuvant-and-systemic-therapy, guidelines, patient-experience-and-advocacy — all status: draft, last-curated: 2026-10-24, pending independent audit. Literature: BIBLIOGRAPHY.md (existing Trozzi annotation, total remains 72), statistics/STATISTICS.md, guidelines/REGISTRY.md, patient-voice/organizations.md and sources.md; the patient wiki’s trial paragraph also reflects the resolved FUCHSia result. OPEN-QUESTIONS.md: OQ-12 moved to Closed; replication and EORTC registry discrepancy added under OQ-6. INDEX.md reconciled (12 open, one answered). Search manifest: 2026-10-24.json. No other condition changed; no publishing or git commands run.

Validation. Scoped checks passed: newly written citation identifiers resolve to this session’s primary API records, edited wiki body citations have reference entries, relative links resolve, four wiki pages have draft status/current dates, and the bibliography remains 72 distinct records. The manifest records the checks. Full-site generation/build and publishing were not run to preserve condition-only scope; independent audit remains pending.

Next sweep. Seek replication of the n=1 FUCHSia response and explanation of its registry/paper totals, not the now-answered enrolment question. Chase EORTC 62113 histology counts/outcomes and 58-versus-59 reconciliation, including any primary publication. Continue NCT07467772 accrual/results and NCT00162721 checks. Retry current NCCN parent algorithm and SFA child pages; watch for an actual ESGO revision. Follow pooled pathology-reviewed SO/LVSI models and SMARCA4/BRG1 frequency series; another isolated mimic case is not a landmark. The independent auditor should check the FUCHSia Efficacy paragraph/Table 1 and the EORTC EU primary endpoint table directly.

2026-10-17 — Periodic literature sweep (since 2026-10-10; author: Claude)

Sources actually queried. PubMed E-utilities esearch/esummary/efetch, window 2026/10/10–2026/10/17 on both edat and pdat, 15 topic queries (all-condition, Müllerian, SO, molecular, epidemiology, imaging, surgery/morcellation, systemic, recurrence, guidelines, patient experience, broad uterine sarcoma, two Cochrane). All-time uterine adenosarcoma 262 (was 261). Every adenosarcoma-restricted topic query returned either 0 or the same single record (PMID 42862247). Broad uterine sarcoma OR uterine sarcomas returned 9 (edat); 8 were other histologies (LMS, LG-ESS, ASPS, myeloid sarcoma, cervical COL1A1::PDGFB, etc.) and were not added. Cochrane-via-PubMed: "Cochrane Database Syst Rev"[jour] AND adenosarcoma 0 all-time; CDSR AND (uterine sarcoma/uterine neoplasms/leiomyosarcoma/morcellation) 0 in window (149 all-time). That is a PubMed-indexed-CDSR finding; cochranelibrary.com and CENTRAL were not queried (HTTP 403 per SOURCES.md).

Europe PMC REST: FIRST_PDATE window returned 0 for adenosarcoma, uterine sarcoma, patient-experience and Cochrane queries. PMID 42862247 was not yet indexed there, so the zero means lag, not absence. A CREATION_DATE window query returned 8, of which the two relevant ones (PMIDs 42835191, 42849401) were already triaged on 2026-10-10. Europe PMC preprints (SRC:PPR): 15 all-time, none in window. OpenAlex: 2 works in window (the same case report, plus an MRI-ADC paper on intrauterine cystic lesions, doi:10.1016/j.jrras.2026.102727, which is not adenosarcoma-specific and was not added). The OpenAlex from_created_date filter returned "plan upgrade required". DOAJ adenosarcoma 129 total; newest record 2026-09-27, already triaged. Crossref was used for the retraction checks. Unpaywall skipped (LIFEBANK_CONTACT_EMAIL unset). ISRCTN adenosarcoma 0. WHO ICTRP not queried (JS portal). SciELO/LILACS not queried (HTTP 403), so no regional-absence claim is made.

ClinicalTrials.gov v2: all 12 cited NCT IDs re-fetched. Status, enrolment, results flag and last-update dates are identical to 2026-10-10: NCT07467772 still recruiting, est. n=30, last update 2026-05-22; NCT00162721 still UNKNOWN, est. n=270; NCT03926936 FUCHSia still hasResults false. query.term=uterine adenosarcoma 5, adenosarcoma 7, query.cond=uterine sarcoma 291 (unchanged). A full-record JSON scan of all 291 found 9 records containing "adenosarcoma", against the 7 reported on 2026-10-10. The two extra are old observational records that mention adenosarcoma only in background text: NCT04123158 (MYLUNAR, last updated 2024) and NCT05881967 (last updated 2023). The difference comes from scan scope, not a new registration.

Guidelines/organisations: NCCN Uterine Neoplasms detail page still lists Version 3.2026 (parent PDF login-gated, not retried). The ESGO guidelines page returns 200 but is JS-rendered with no sarcoma text in the static HTML, so no update could be detected. NCI PDQ (health professional) is unchanged: updated 2024-12-17, still names adenosarcoma. FWC, Sarcoma UK and Sarcoma Alliance return 200; SFA (curesarcoma.org) is still HTTP 403. No new registry/burden statistics, guideline, or adenosarcoma-specific patient-voice material was found. REGISTRY.md, STATISTICS.md and patient-voice/ were left unchanged.

Retraction. PMIDs 42862247, 38113031 and 34271067 have no Retracted Publication or Expression of Concern publication type. Crossref updated-by is empty for all three DOIs.

What survived triage. One in-window record, plus two older records that the targeted query adenosarcoma AND (SMARCA4 OR BRG1 OR SWI/SNF OR SMARCB1) (9 all-time) showed the molecular page had never covered: 1. Rosas-Chavez 2026, PMID 42862247 (abstract read). Case report: a 27-year-old whose curettage showed high-grade adenosarcoma. The tumour had epithelioid/rhabdoid stroma and extensive LVSI; NGS found a SMARCA4 mutation and no other mutation; she died at 19 months. 2. Wei 2024, PMID 38113031 (abstract read). Case report: a BRG1-lost tumour with phyllodiform adenosarcoma-like architecture, overlapping undifferentiated uterine sarcoma, adenosarcoma with SO, and mixed carcinoma. 3. Kihara 2021, PMID 34271067 (abstract read). IHC screen of 206 uterine mesenchymal tumours; the 2 adenosarcomas among them retained SMARCA4/SMARCA2. These are graded on the page as two case reports plus n=2 negative IHC observations. The page frames them as a differential-diagnosis point, not a frequency estimate. No deep note; this is not a landmark.

Pages changed. molecular-and-genomic-features.md: new short section + refs 11–13; curated → draft; last-curated: 2026-10-17. clinical-trials-landscape.md: registry-scan sentence corrected (7 → 9 string matches, with the two new ones explained); stays draft; last-curated: 2026-10-17. BIBLIOGRAPHY.md now holds 72 PMIDs (was 69). OPEN-QUESTIONS.md: OQ-4 sharpened (SMARCA4 IHC in the high-grade work-up; frequency of SMARCA4 loss unmeasured). INDEX.md: counts, molecular status, curation-state line. Manifest: literature/sweeps/2026-10-17.json. No other wiki page touched.

Not done / carried forward. The Trozzi 2024 FUCHSia full text is still unavailable: Europe PMC reports isOpenAccess N and not in PMC, so the adenosarcoma subset (OQ-12) remains unknown. None of the three new records was opened in full text; claims are restricted to what the abstracts say.

Next sweep. Recheck Europe PMC for PMID 42862247 once it is indexed (full-text availability). Follow-ups still open: FUCHSia subset (OQ-12); NCT07467772 accrual; NCCN sarcoma chapter if a non-login source appears; an ESGO page update (needs a non-JS route); SFA. Watch for any series measuring SMARCA4/BRG1 loss across conventional adenosarcomas, which would turn the new OQ-4 sentence from a differential note into a frequency. The independent auditor should verify the molecular-page addition against the Wei 2024 PMC full text (PMC11166733).

2026-10-10 — Periodic literature sweep (since 2026-09-01; author: Grok)

Sources actually queried. PubMed E-utilities esearch/esummary/efetch with window 2026/09/01:2026/10/10 on both [edat] and [dp]. Topic queries: pathology/diagnosis, sarcomatous overgrowth, molecular, epidemiology, imaging, surgery, systemic therapy, recurrence, guidelines, morcellation, patient experience. All-time counts: uterine adenosarcoma 261 (was 258 on 2026-09-01). Cochrane-via-PubMed: "Cochrane Database Syst Rev"[jour] AND adenosarcoma 0 in the window and 0 all-time; same for "uterine sarcoma(s)" in the window and all-time. This is a PubMed-indexed-CDSR finding. cochranelibrary.com returned HTTP 403; CENTRAL was not searched.

Europe PMC REST /search with FIRST_PDATE:[2026-09-01 TO 2026-10-10]: adenosarcoma-restricted query 8 hits (matching the PubMed set plus the already-PMID mini-review); patient-experience 0; Cochrane-window 0. OpenAlex window search 11 works. DOAJ uterine adenosarcoma 88 total (no new 2026-09+ article beyond papers already seen). Crossref DOI resolution and empty updated-by for every record added. Unpaywall skipped (LIFEBANK_CONTACT_EMAIL unset). SciELO search HTTP 403. LILACS/BVS search timed out; no regional-absence claim is made. WHO ICTRP portal HTTP 200 but JS-driven; programmatic search not counted. ISRCTN search returned a cookie-holding page. ChiCTR response was not usable as results. CTRI returned the search form without a populated result set. EudraCT adenosarcoma returned FUCHSia (2017-005018-76) and EORTC 62113 (2013-000762-11), already tracked.

ClinicalTrials.gov v2: query.term=uterine adenosarcoma 5; query.term=adenosarcoma 7; query.cond=uterine sarcoma 291 (was 287). Record-level scan of all 291 found 7 records containing “adenosarcoma”; no new eligibility-named protocol. All 12 previously cited NCT IDs re-fetched: no status, enrolment, or results-posting change that alters the landscape. Elacestrant NCT07467772 still recruiting, estimated n=30, last update 2026-05-22. NCT00162721 still UNKNOWN, estimated n=270, no posted results.

Guideline/org checks: ESGO guidelines page 200; previously cited pocket PDF HTTP 404. NCCN guidelines-detail page lists Uterine Neoplasms Version 3.2026; parent PDF still login-gated. NCI health-professional PDQ live (summary 2024-12-17) and still names adenosarcoma with the FIGO table; the former patient PDQ URL now redirects to a general hub that does not contain “adenosarcoma” on this fetch. FWC, Sarcoma UK, Sarcoma Alliance, ACS 200. SFA HTTP 403 again. No new adenosarcoma-specific qualitative study in PubMed or Europe PMC.

Retraction. Added records (PMIDs 42794871, 42706489, 38724237) have ordinary PubMed publication types (no Retracted Publication / Expression of Concern). Crossref updated-by empty for their DOIs.

What survived triage. Eight PubMed adenosarcoma hits in the date window. Most were class-level reviews, IHC of PEComa mimics, or case reports of known phenomena (endometriosis-associated Müllerian adenosarcoma; unexpected SO after polypectomy). Those were not added. A no-PMID OpenAlex/Crossref cervical-adolescent case (doi:10.1093/rescon/vmag176) was resolved and left out (wrong site, case report).

Three records were added:

  1. Aytekin 2026, PMID 42794871 (PMC full text read). Seven-centre Turkish retrospective cohort, n=43, 2016–2026, no central review. Stage I 34/43. SO (defined as more than 25%) 19/43 (44.1%). LVSI 8/43. Recurrence 15/43 (34.9%), pelvis 9/15, thorax 3/15. 5-year DFS 59.9%, OS 80.4%. SO independently associated with DFS (HR 4.41, 1.21–16.08) and OS (HR 10.23, 1.16–89.80); LVSI with OS (HR 11.17, 1.34–93.14) but not DFS. Authors flag 10 deaths and wide CIs. Independent of MD Anderson; does not close OQ-1. No landmark note (confirmatory, small events, no path review).
  2. Kajiyama 2026, PMID 42706489 (abstract; Wiley XML full text not served). JSOG 2023 patient report: 54 uterine adenosarcomas vs 533 uterine sarcoma. Survival tables are cervical/endometrial/ovarian only.
  3. Trozzi 2024, PMID 38724237 (abstract; full text subscription-blocked). FUCHSia primary paper, found via the standing OQ-12 / LOG follow-up rather than the date window. 15 analysed patients (registry actual n=17); uterine sarcoma n=4 with 1 PR + 3 SD. Retrieved abstract does not give an adenosarcoma headcount. ClinicalTrials.gov still hasResults false. OQ-12 sharpened, not closed.

Pages changed (all edited wiki pages status: draft, last-curated: 2026-10-10): overview, sarcomatous-overgrowth, epidemiology-and-burden, staging-and-prognostic-factors, surgical-management, adjuvant-and-systemic-therapy, recurrence-and-surveillance, clinical-trials-landscape, guidelines, clinical-presentation-and-imaging (PDQ URL correction only), patient-experience-and-advocacy. Literature: BIBLIOGRAPHY.md (66→69 PMIDs), STATISTICS.md, guidelines/REGISTRY.md, patient-voice organizations.md and sources.md, OPEN-QUESTIONS.md (OQ-1, OQ-6, OQ-12, D3 date), INDEX.md. Manifest: literature/sweeps/2026-10-10.json. Pathology, molecular, and red-flags pages untouched. No new deep note.

Next sweep. Retrieve Trozzi 2024 full text / supplement for the adenosarcoma subset (OQ-12). Recheck NCT07467772 accrual and NCT00162721. Retry NCCN v3.2026 sarcoma chapter if a non-login source appears. Retry ESGO pocket PDF under a new URL. Follow any pooled path-reviewed SO/LVSI model (OQ-1). Recheck PubMed CDSR for adenosarcoma. Retry SFA if it becomes fetchable. Do not treat another confirmatory n<50 retrospective series as a landmark.

2026-09-01 — Independent audit (Codex auditor; Grok author)

Codex independently audited all 14 wiki pages and all 13 literature artifacts authored by Grok. The audit re-fetched 66/66 distinct PMIDs through live PubMed E-utilities and 12/12 distinct NCT records through the live ClinicalTrials.gov v2 API; every identifier resolved and matched the paper or trial now attributed to it. It checked 672 in-text identifier-linked claim–citation pairs outside wiki reference lists and the master bibliography (626 PMID-linked occurrences + 46 NCT-linked occurrences). Wiki body/reference sets, bibliography coverage, front matter, reference numbering, and local links were also reconciled. All 14 pages passed after repair and were promoted to status: curated.

Errors found and fixed. Each item below changed the authored material rather than merely recording a concern.

  1. Mitotic denominator: Zaloudek’s proposed threshold had been reported as 4 mitoses/10 HPF. The live record says 4/100 HPF. Corrected in pathology and the Clement landmark note, with an explicit warning not to conflate it with Clement’s separate 2/10-HPF criterion.
  2. Trial absence was stale and too broad: a full record-level scan of all 287 ClinicalTrials.gov uterine sarcoma results found the mixed-histology randomised phase 3 registration NCT00162721, which explicitly included adenosarcoma. It has UNKNOWN status, estimated n=270, no posted results, and no retrieved adenosarcoma-specific publication. The defensible gap is therefore no adenosarcoma-only randomised trial and no reported histology-specific randomised outcome—not “no trial has ever run.” The audit also added eligible records NCT03509207 (vorinostat; terminated, n=3) and NCT05481645 (immunochemotherapy ± anlotinib; terminated, n=71), updated NCT01979393 to its completed actual n=58 record, and preserved FUCHSia and elacestrant with current status.
  3. Registry false positives: NCT02020707 carries a “cervical adenosarcoma” condition tag but its eligibility permits epithelial cervical cancers and not adenosarcoma; NCT07394413 is a likely miscoded cervical-adenocarcinoma observational study. DART (NCT02834013) does not name adenosarcoma or uterine sarcoma in the retrieved eligibility text. All three are now labelled accurately rather than presented as disease trials.
  4. Molecular-fusion absence was obsolete: the live PubMed search found Agaimy 2026 (PMID 41555057), a 12-case series of adenosarcoma-like uterine neoplasms with recurrent ESR1::NCOA3/2 fusions. The molecular page now reports the finding while preserving the authors’ unresolved classification versus conventional adenosarcoma and UTROSCT; it is not presented as diagnostic-assay validation.
  5. Patient-voice absence needed qualification: Ziegler 2026 (PMID 42334466) contains a short perspective from one fertility-sparing patient. It is now included and explicitly graded as n=1 case-report evidence, while the dated gap is no adenosarcoma-specific qualitative cohort.
  6. Recurrence overstatement: “at least 50% recur” had been used as though it were a general cohort rate. It is now identified as a narrative-review synthesis and set beside primary, case-mix-dependent estimates: Clement 23/100 overall and Carroll stage I 77% with SO versus 22% without.
  7. Epidemiology comparison error: the text had causally attributed a higher SEER share to inclusion of carcinosarcoma. The datasets and denominators are now described as non-comparable without claiming that untested explanation. A synthetic “SO ~25–35%” working average was also removed; series estimates remain side by side with their selection frames.
  8. Publication metadata: Qu was dated 2021; the live citation is Frontiers in Oncology 2020 (PMID 33680946). Harada’s citation was updated to its final 2025 volume/pages. Reference numbering gaps created by deleted citations were repaired.
  9. Diagnostic-mechanism overstatement: preoperative biopsy/imaging failure had been described as frequent and as the established mechanism of morcellation. The sources provide an “occasional” qualitative statement plus five recurrent-polyp cases, not a failure rate. The page now states the inference and its unmeasured frequency explicitly.
  10. Molecular and pathology absences: blanket statements that no diagnostic molecular/IHC test exists, that BAP1 is “not tested,” and that PI3K-pathway findings had reached zero trials were converted to dated search results with precise scope: no prospectively validated diagnostic assay, no retrieved BAP1 diagnostic-accuracy validation, and no PI3K-pathway-selected adenosarcoma trial as of 2026-09-01.
  11. Other absence claims re-searched and dated: no prospective imaging diagnostic-accuracy study, no prospective surveillance-schedule comparison, no continuous-volume SO outcome model, no central-review population incidence estimate, no study of initially missed SO rates, no adenosarcoma-specific sexual-function score, and only one adenosarcoma-plus-morcellation PubMed hit (a case report, PMID 27769260). Bare [unverified] markers were removed.
  12. Guideline scope: GCIG’s literal “no trials” sentence was narrowed in light of NCT00162721. The accessible NCCN Insights paper (PMID 40763788) is endometrial-focused; both official parent-guideline PDF endpoints returned sign-in HTML on 2026-09-01. Claims about current NCCN adenosarcoma recommendations were removed rather than inferred. ESGO recommendations were rechecked against the live pocket-guideline PDF.
  13. Patient-resource drift: the old American Cancer Society “questions to ask” URL now redirects to a general detection/diagnosis/staging hub, so the obsolete question-list claim was removed. Sarcoma Foundation of America returned HTTP 403 to automated re-fetch; changing dollar, grant, trial, and service counts were removed. Other directory pages were re-fetched, and closed communities were not accessed.
  14. Evidence grading and reconciliation: case reports, literature-assembled cases, single-institution retrospective cohorts, registries without central review, and mixed-histology trials are now labelled as such at the point of use. The bibliography contains all 66 cited PMIDs and no uncited PMID; every wiki body PMID appears in that page’s reference list and vice versa.

What remains flagged. There is no unresolved substantive citation issue and no live [unverified] marker in the audited wiki or literature layer. Two access limitations remain as positively stated, dated gaps: the current NCCN parent algorithm could not be retrieved without sign-in, and SFA’s site blocked automated access. Trial-result gaps also remain factual: NCT00162721 has unknown status/no posted results, and the retrieved basket trials do not report an adenosarcoma-specific efficacy estimate. These limitations do not support any affirmative clinical claim and therefore did not prevent curation.

Status: all 14 pages curated; condition advanced to audited in CONDITIONS-ROADMAP.md.

2026-08-31 — Full build (Grok)

Built all 14 canonical wiki pages from live literature, plus the literature layer, a rewritten OPEN-QUESTIONS.md, and an updated INDEX.md. Every page left status: draft for independent audit by a different engine. CONDITIONS-ROADMAP.md status → built. Density-exempt rule observed: pages are as long as the sources support; case reports are labelled as case reports.

Seed-anchor re-verification (all six PMIDs resolved live). Two attributions in the seed INDEX were wrong and were corrected rather than repeated: - PMID 29441675 is Tate K et al., not Tanaka H. Title and numbers (110 assembled cases; 34% disease-specific death; stage IA 13% recurrence / 3.3% mortality) match the abstract; the first-author error is corrected throughout. - PMID 26646120 is Raine-Bennett T et al., not Multinu F. Occult sarcoma 1/278 (3.60/1,000, 95% CI 2.97–4.23) is this paper. The Multinu occult-sarcoma paper is PMID 30447212 (2019, Olmsted County) and was added as a separate source.

Literature size re-measured. uterine adenosarcoma esearch count 258 (unchanged). Sarcomatous-overgrowth query 142 (broader than the seed’s 46 because of Müllerian/overgrowth expansion). Molecular query 39. No population-incidence paper with central review was found.

Searches run (PubMed E-utilities, this session). Topic queries included: uterine adenosarcoma (count); SO; molecular/MDM2/CDK4/TERT; SEER/population/incidence; hysterectomy/lymphadenectomy/oophorectomy/fertility; chemotherapy/radiotherapy/hormonal/adjuvant; recurrence/surveillance; MRI/imaging; guideline/ESMO/NCCN/FIGO; morcellation; Clement Scully; author-targeted (Seagle, Tanner, Arend, Kaku, Zaloudek, Nathenson, Friedlander, McCluggage, Gallardo, Verschraegen, Machida, Nucci, Pinto, Hodgson, DICER1, BCOR, Prat FIGO, ESGO, tamoxifen, ifosfamide, trabectedin, pazopanib); Brooks SEER; qualitative/HRQoL. Abstracts fetched via efetch for all papers cited. No PMID was written from memory.

ClinicalTrials.gov v2 (this session). query.term=uterine adenosarcoma → 5 studies; query.term=adenosarcoma → 7; query.cond=uterine sarcoma → 287 (almost none adenosarcoma). Named-eligibility trials: NCT03926936 FUCHSia (completed, n=17, no PubMed results paper); NCT07467772 elacestrant (recruiting, estimated n=30); NCT01979393 EORTC 62113 cabozantinib (protocol PMID 32546554). DART NCT02834013 eligibility text does not contain “adenosarcoma”. Finding: no dedicated adenosarcoma randomised trial.

Pages written (all draft). overview, pathology-and-diagnosis, sarcomatous-overgrowth, molecular-and-genomic-features, epidemiology-and-burden, clinical-presentation-and-imaging, staging-and-prognostic-factors, surgical-management, adjuvant-and-systemic-therapy, recurrence-and-surveillance, guidelines, clinical-trials-landscape, red-flags-and-safety-concerns, patient-experience-and-advocacy.

Literature layer. BIBLIOGRAPHY.md; 6 landmark notes (Clement 1989 SO, Clement 1990, Carroll 2014, Howitt 2015, Nathenson 2018 LVSI, Seagle 2016 NCDB); guidelines/REGISTRY.md (10 documents); statistics/STATISTICS.md; patient-voice/ (README, organizations, themes, sources) with ethics rules observed. No adenosarcoma-specific qualitative study exists; den Hollander 2022 (PMID 35443673) is mixed uterine sarcoma n=13.

Patient organisations fetched. Foundation for Women’s Cancer, Sarcoma UK, Sarcoma Foundation of America, Sarcoma Alliance, NCI PDQ, ACS question-prompt page. Closed groups signposted only.

Could not verify / left explicit. - Full NCCN Uterine Neoplasms sarcoma algorithm (Insights 2025 PMID 40763788 is endometrial-focused); parent-guideline sarcoma wording marked [unverified] beyond that paper. - FUCHSia results (completed 2022, not PubMed-indexed this session). - EORTC 62113 primary results as an adenosarcoma subset analysis. - Population incidence of uterine adenosarcoma per 100,000 with central review — not in the retrieved set. - Adenosarcoma-specific morcellation outcomes — one case report (PMID 27769260). - FIGO 2009 stage table body: Prat PMID 19135669 is a short communication without a usable abstract; IA/IB/IC invasion substaging was confirmed against NCI PDQ (fetched) and secondary tables, and is cited as Prat 2009 plus NCI PDQ access date.

Follow-ups for the auditor / next sweep. 1. Re-fetch every cited PMID; check Carroll HRs, Raine-Bennett 1/278, Tate vs Tanaka, Raine-Bennett vs Multinu. 2. Re-query ClinicalTrials.gov for FUCHSia results and NCT07467772 accrual. 3. If an adenosarcoma-specific qualitative study appears, it should replace the mixed-sarcoma default in patient-voice/themes.md. 4. Do not inflate citation counts to clear a density threshold.

Next: independent audit by a different engine; then ROADMAP → audited if the audit passes.

2026-08-31 — Seeded

  • Created the condition scaffold (INDEX.md, OPEN-QUESTIONS.md, LOG.md, wiki/, literature/) per CLAUDE.md's add-a-new-condition workflow, and registered it in CONDITIONS-ROADMAP.md under Cancer.
  • Ran live PubMed scoping searches and recorded six resolved anchor records. Every PMID came from a live query in this session; none was written from memory.
  • Measured the size of the literature before designing the page list, which turned out to be the decision that shaped everything else: 258 total records for the condition, 46 on sarcomatous overgrowth, 20 on molecular features, 3 population-based. Most of the corpus is case reports and single-institution retrospective series; the largest cohort found while scoping was 74 patients with multivariable analysis, and the largest dataset a 797-patient SEER extract without central pathology review.

Two scoping decisions follow from that.

  1. Fourteen pages, not the usual 19–20. Mechanism, prevention and risk-factor pages that earn their place in a common condition would be empty here. Sarcomatous overgrowth gets a page of its own because it is the one consistently supported prognostic variable and the single most decision-relevant fact about the disease.
  2. Density-exempt. .density-exempt records why: fourteen pages at 24 citations each would require 336 citation-slots from a 258-record literature, reachable only by citing case reports as evidence. The build and any future deepen pass must not inflate this condition to clear a threshold designed for common diseases.

A framing instruction for the build. In most conditions here, "open question" means the evidence leaves a decision unresolved. In this one it usually means no adequately powered study exists, because the disease is too rare for one. Those are different claims and must not be written as though they were the same; a question answerable only by a rare-tumour consortium or registry should say so rather than proposing a trial nobody can run.

Next: full build from live literature, then an independent audit run by a different model than the one that wrote the pages.