A case of uterine adenosarcoma with liver metastasis causing early postoperative hepatorrhexis

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  • AOYAMA Kohei
    Department of Obstetrics and Gynecology, North Medical Center, Kyoto Prefectural University of Medicine
  • KUROBOSHI Haruo
    Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
  • MATSUSHIMA Hiroshi
    Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
  • TATSUMI Hiroshi
    Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
  • MORI Taisuke
    Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
  • NOGUCHI Toshifumi
    Department of Obstetrics and Gynecology, North Medical Center, Kyoto Prefectural University of Medicine
  • KITAWAKI Jo
    Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine

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  • 術後早期に肝転移をきたし肝破裂に至った子宮腺肉腫の1例
  • 症例報告 術後早期に肝転移をきたし肝破裂に至った子宮腺肉腫の1例
  • ショウレイ ホウコク ジュツゴ ソウキ ニ カン テンイ オ キタシ カン ハレツ ニ イタッタ シキュウセン ニクシュ ノ 1レイ

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<p>Uterine adenosarcomas are rare mixed epithelial-mesenchymal tumors containing benign glandular and malignant stromal components; these tumors account for approximately 8% of all uterine sarcomas. An adenosarcoma with sarcomatous overgrowth--that has a pure sarcoma component occupying more than 25% of the tumor--is predictive of a poor prognosis. The patient was 56 years old, with gravida 6 para 2. She had been followed up as uterine myoma for eight years before visiting our hospital. USG showed a tumor (5 cm) consisted of echo-free part and solid part. T2 weighted MRI showed the tumor consisted of two parts with different signal, slight high and remarkable high. We performed abdominal hysterectomy and a bilateral salpingo-oophorectomy for the pathological diagnosis to exclude sarcoma. A large part of the tumor was occupied with sarcoma component consisted of atypical mesenchymal cells. A few epithelial component was mixed in the tumor edge. The patient was diagnosed with uterine adenosarcoma, pT1cNxM0. Any recurrence could not be detected after 90 days of surgery. However a liver metastasis lesion was suddenly ruptured after 96 days. Transcatheter arterial embolization was performed at another hospital, and then, the patient was transferred to our hospital. Her condition rapidly deteriorated, and she died after 118 days. Uterine adenosarcomas are generally low-grade malignant tumors, and the incidence of early recurrence and tumor death is less. However, uterine adenosarcomas with sarcomatous overgrowth have a poor prognosis. Furthermore, the preoperative diagnosis is difficult. Thus pathological diagnosis is necessary to exclude malignancy. In cases of uterine adenosarcomas with sarcomatous overgrowth, we should be cautious about the possibilities of distant metastasis and local recurrence. In addition, it is important to detect recurrent lesions via a systemic search starting from the early postoperative period. [Adv Obstet Gynecol, 69 (2) : 138-144, 2017 (H29.5)]</p>

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