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Clement PB. Müllerian adenosarcomas of the uterus with sarcomatous overgrowth. A clinicopathological analysis of 10 cases. Am J Surg Pathol. 1989;13(1):28-38. PMID 2535774

One-paragraph summary

Ten women aged 32–82 (median 59) with Müllerian adenosarcoma in which a pure sarcoma overgrew typical adenosarcoma and accounted for 25–80% of tumour volume. In 7 of 10 the pure sarcoma was higher grade and more mitotic than the adenosarcomatous stroma; in 3 the two components looked similar. Six invaded myometrium, three to serosa. One had bilateral ovarian and peritoneal metastases at hysterectomy. Seven recurred, including four with hematogenous metastases, at 9 months to 6 years; six died of tumour at 9 months to 10 years; three were alive without recurrence at 4–7 years. Clement’s conclusion: in contrast to typical adenosarcoma, adenosarcoma with sarcomatous overgrowth is aggressive.

Key findings

  • Operational definition: pure sarcoma occupying 25–80% of tumour volume — the ≥25% threshold still used.
  • Hematogenous metastasis in 4/10, against 2/100 in the subsequent typical-adenosarcoma series.
  • Fatal outcome in 6/10.

Limitations

  • n=10, selected for the presence of overgrowth (not a prevalence series).
  • No multivariable analysis; invasion and SO are entangled.
  • The 25% cut was descriptive, not ROC-optimised.

Why it matters

This paper created the variable that every later series stratifies on. Carroll, Tanner, Nathenson, Howitt, French GSF and ESGO all use this definition. A 10-case series remains the definitional source of the field’s most important prognostic factor.

Cited by wiki pages

  • overview
  • sarcomatous-overgrowth
  • recurrence-and-surveillance
  • red-flags-and-safety-concerns