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Clement PB, Scully RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol. 1990;21(4):363-81. PMID 2156771

One-paragraph summary

One hundred Müllerian adenosarcomas of the uterus in patients aged 14–89 (median 58), usually presenting with abnormal vaginal bleeding. Enlarged uterus and tissue protruding from the os were the common pelvic-exam findings; five patients had presented on multiple occasions with “recurrent polyps” later recognised as adenosarcoma. Grossly, polypoid masses filled the endometrial cavity. Histology: benign or atypical glands in a sarcomatous stroma forming periglandular cuffs and/or intraglandular polypoid projections; homologous stroma in 78%, heterologous in the rest; stromal mitoses 1–40 per 10 HPF (mean 9). Myometrial invasion in 15, deep in 4. Recurrence in 23 at 0.5–9.5 years (mean 3.4), ≥5 years in one third of recurrences; almost always vagina/pelvis/abdomen, hematogenous in 2. Myometrial invasion was the only feature associated with increased recurrence risk. Criteria proposed versus adenofibroma: ≥2 stromal mitoses/10 HPF, marked stromal cellularity, and/or significant stromal atypia, alone or in combination.

Key findings

  • Recurrence 23/100; late recurrence is part of the natural history (one third ≥5 years).
  • Invasion, not heterologous elements or mitotic rate, associated with recurrence in this series.
  • Diagnostic criteria versus adenofibroma used ≥2/10 HPF, whereas Zaloudek and Norris used ≥4/100 HPF; the denominators differ and the cut-points are not directly comparable.

Limitations

  • Pre-FIGO-2009, pre-SO-as-standard-variable (Clement’s SO paper is 1989, PMID 2535774, and SO is not the stratifier here).
  • No multivariable survival model.
  • Single-pathologist era expert series from consultation material, with referral bias.

Why it matters

This is the series that made adenosarcoma a countable clinicopathologic entity after the 1974 ten-case description (PMID 4371193). Every subsequent recurrence-timing, late-relapse, and recurrent-polyp claim traces here. The adenofibroma criteria it proposed remain in use and remain unvalidated against outcome.

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