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"referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Saúl" "apellidos" => "De Burgos González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Rezola Bajineta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Manuel" "apellidos" => "Moreno Valladares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Yessica Paulina" "apellidos" => "Rodríguez Velandia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Begoña" "apellidos" => "Aguiar Losada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Iraide" "apellidos" => "Bernal Simón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Paloma" "apellidos" => "Cobas Lozano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Irune" "apellidos" => "Ruiz Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Surgical Pathology in the University Hospital Donostia in San Sebastian, Basque Country, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Gynecology in the University Hospital Donostia in San Sebastian, Basque Country, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adenosarcoma mülleriano con sobrecrecimiento sarcomatoso y elementos heterólogos: informe de caso y revisión bibliográfica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1868 "Ancho" => 2007 "Tamanyo" => 762256 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Exophytic lesion with hypercellular stroma and broad-based phyllodes-like projections (A, haematoxylin–eosin (H–E) 10×), double component, epithelial and stromal. (B, H–E 20×) and atypical stromal cells arranged in a dense “cuffing” around the bland epithelial glands (C, H–E 40×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Mullerian adenosarcoma (MA) is a rare biphasic tumour, usually located in the uterus.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Postmenopausal women are most often affected and abnormal bleeding is the most common symptom.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,5,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It usually carries a good prognosis, although the presence of sarcomatous overgrowth (SO) and heterologous elements (HE) worsens the prognosis of the condition.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 63-year-old woman diagnosed in our institution with uterine mullerian adenosarcoma with sarcomatous overgrowth (MASO) and presence of HE.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 63-year-old woman with menopause at 58 years of age and no significant comorbidities presented with abnormal vaginal bleeding lasting 12 days and sensation of solid material coming out of the cervix.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Physical examination showed an excrescent tumour, appearing through the endocervical os. Magnetic resonance imaging revealed a 10<span class="elsevierStyleHsp" style=""></span>cm-uterine tumour occupying the endometrial cavity. Myometrial infiltration further than 50%, with probable superficial involvement of the cervical stroma, signs suggestive of infiltrate in the left vaginal fundus and an undetermined adenopathy in the left internal iliac chain were reported.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Biopsies of the exophytic mass and endometrium were performed. Multiple fragments of the mass and a polypoid endometrial fragment were received in our department.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The first sample presented necrotic areas and infiltrative discohesive, spindle-shaped or rhabdoid cells, with moderate to severe pleomorphism, lined by a bland-looking surface epithelium with a slight increase in mesenchymal subepithelial cellularity. Some bland-looking trapped glands were identified.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the endometrial biopsy, the histological findings were similar, with up to 10 mitoses in 10 high power fields (hpf) in the stromal component, frequently atypical. Bland glands with subtle atypical cuffing around them were identified.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Immunohistochemical (IHC) studies revealed expression for vimentin, CD10, desmin, MYO-D1 and myogenin in the most hypercellular areas, being negative for pan-cytokeratin, CD45, S100 and smooth muscle actin.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The diagnosis made was “high-grade sarcoma with rhabdoid muscle differentiation”, proposing, in an explanatory note, the differential diagnosis between carcinosarcoma (having obtained only the sarcomatous part in the submitted sample), high-grade endometrial stromal sarcoma and, more remotely, leiomyosarcoma with rhabdoid differentiation.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The patient was submitted to total hysterectomy with double adnexectomy, which we received in our department.</p><p id="par0065" class="elsevierStylePara elsevierViewall">With a weight of 175<span class="elsevierStyleHsp" style=""></span>g, the uterus presented an exophytic polypoid lesion dependent on the endometrial cavity and protruding through the cervical canal. Measuring 10<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm, macroscopically it seemed to invade the myometrial surface.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Histologically, the findings were similar to those of the previous biopsies, also appreciating a phyllodes-like architecture and an evident atypical sarcomatous cuffing around the bland glands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Higher cellular areas were identified, absent of epithelial component, with a marked stromal atypia and which accounted for more than 25% of the tumour volume. The tumour showed areas of necrosis and HE, particularly cells with rhabdoid differentiation (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Forty-five mitotic figures were identified in 10<span class="elsevierStyleHsp" style=""></span>hpf, frequently atypical.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Superficial myometrial infiltration was observed. Cervix, parametrium, tubes and ovaries were free of involvement.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The IHC study remarked the positivity for hormonal receptors (HR) in both the epithelial and stromal components and CD10 positivity in the sarcomatous stromal component, although patchy in the rhabdoid component. In these latter areas, immunoexpression for MYO-D1 was also patchy. Immunostaining with SMARCA4 was retained (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Ki67 was assessed at 28%. P53 showed wild type (W-T) staining in both epithelium and stroma.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The differential diagnosis (DD) was established between a biphasic tumour with a benign epithelial component and a malignant stroma or a pure endometrial sarcoma that traps benign endometrial glands in its growth.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The presence of glands in different areas of the tumour, not rejected to the periphery and with mesenchymal reinforcement, led us to think of a biphasic tumour. The bland epithelium, the phyllodes-like architecture, the SO, the HE and the retained staining for SMARCA4 allowed considering MASO with HE as the first diagnostic possibility.</p><p id="par0105" class="elsevierStylePara elsevierViewall">However, in order to rule out carcinosarcoma, we performed total inclusion of the specimen in search of epithelial malignancy, which was not observed.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Therefore the diagnosis was uterine mullerian adenosarcoma (high grade) with SO and presence of HE (rhabdomyoblastic).</p><p id="par0115" class="elsevierStylePara elsevierViewall">It infiltrates 5<span class="elsevierStyleHsp" style=""></span>mm into the myometrium (less than 50% in depth). No lymphovascular or perineural invasion was observed and the surgical margin was free. FIGO IB.</p><p id="par0120" class="elsevierStylePara elsevierViewall">After a follow-up computer tomography scan, 7 months after surgery, 4 pulmonary nodules suspicious for metastasis were identified and the patient received palliative chemotherapy with 6 cycles of doxorubicin. In the post-chemotherapy follow-up studies, the nodules are present without significant changes and without other images of progression.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">MA was described by Clement and Scully in 1974.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> It is a biphasic tumour consisting of a benign epithelial component and a malignant mesenchymal component. It accounts for less than 0.5% of uterine neoplasms.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">They are usually located in the uterus, but have been described in the cervix (5–10% of cases), vagina, fallopian tubes, ovary and paraovarian tissue.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> It can arise over areas of endometriosis and adenomyosis.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The age range of presentation is wide, but most of them occur in postmenopausal women, with the median age in the 5th decade of life. When it occurs in extrauterine locations, it usually occurs in younger women.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,3,7,11</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The most frequent clinical presentation is abnormal vaginal bleeding (71% of cases), followed by pelvic mass which usually protrudes through the external cervical os (37%).<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Macroscopically it typically presents as a single mass occupying the uterine cavity with a firm surface and areas of haemorrhage or necrosis in up to 25% of cases.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,3,5,14</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Histologically it is defined by a benign glandular component, often with cystic dilatation and malignant mesenchyma, which is often seen more densely cellular around these glands, in a typical “cuffing enhancement”.</p><p id="par0155" class="elsevierStylePara elsevierViewall">It is usually a low-grade neoplasm, with a recurrence rate of 15–25% and a disease-free progression of 100% at 2 years.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">However, there are clinical and histological criteria that worsen its prognosis or make it a high-grade tumour.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Among the clinical criteria, the primary extrauterine location, recurrence or the presence of lymph node or distant metastases worsen the prognosis.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Among the histological criteria, those that mainly overshadow the prognosis are the presence of HE, myometrial invasion and the presence of SO, the last two being those that worsen the prognosis the most.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,3,5,6,11,14</span></a> The identification of 4 or more mitosis figures per hpf classifies the tumour as “high grade”, although some authors consider MASO as a high-grade tumour regardless of its mitotic index.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,5,6</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">The presence of HE is observed in 20–25% of cases of MA and the rhabdomyoblastic element is the most frequently found. Other HE described are smooth muscle or cartilage, as well as differentiation of sex cord-like.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,4,5</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Myometrial invasion occurs in up to 15% of cases, which is deep in only 5% of cases and increases the risk of recurrence from 7% to 36%. Overall survival in patients with myometrial invasion is 60%.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">MASO was described in 1989 by Clement.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> It is defined by the presence of more than 25% sarcomatous component. In these areas, the epithelial component is typically absent and higher mesenchymal cellularity is generally observed, with more striking atypia and more figures of mitosis. It occurs in about 10% of the cases of adenosarcoma and presents myometrial invasion more frequently.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">In the literature reviewed we found no significant clinical, epidemiological and localization differences between MA and MASO.</p><p id="par0195" class="elsevierStylePara elsevierViewall">In the IHC studies, the sarcomatous component of MASO usually expresses a higher Ki67 and a higher frequency of aberrant P53 expression than in MA. Conversely, CD10, WT1 and HR expression is more consistent in the stroma of MA.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,5–7,14</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Genetically, TP53 mutations appear rarely in MA, but may be more frequent if SO is present.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">When SO is observed, the recurrence rate rises to 45–70%,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> the 2-year progression-free disease decreases from 100% to 20% and 5-year survival from 80% to 50%,<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5,13</span></a> with a median overall survival of 55 months.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Some authors equate MASO and carcinosarcoma in terms of prognosis.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">The expression of CD10, HR or Ki67 less than or equal to 20% in the SO component of a MASO indicate a slight improvement in the prognosis.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Both myometrial invasion and the presence of SO favour the existence of lymph node metastases, these being a rare event in any case.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">The differential diagnosis is established mainly between other biphasic tumours or mesenchymal tumours that trap normal epithelial structures in their growth.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5–7,13</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">The biphasic tumours include adenofibroma, in which the stromal component is not atypical; atypical polypoid adenomyoma, which shows epithelial atypia with frequent morular squamous metaplasia and a bland or mildly atypical mesenchyma<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5–7,13,15</span></a>; carcinosarcoma, occurring with both malignant epithelial and mesenchymal component and requires an exhaustive sampling or total inclusion of the specimen to rule it out.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Mesenchymal tumours include endometrial sarcoma, which lacks the periglandular mesenchymal cuff and the phyllodes-like architecture<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5–7</span></a> and SMARCA4-deficient endometrial sarcoma, in which rhabdoid features are present and phyllodes-like architecture may be observed, although periglandular mesenchymal enhancement is not a typical feature and, immunohistochemically, shows negativity for SMARCA4 in the stromal sarcomatous component.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The standard treatment for MA is radical hysterectomy with double adnexectomy. Hysterectomy without oophorectomy or polypectomy can be proposed for premenopausal women or those with unfulfilled reproductive desires and without poor prognostic data, conditioning a closer follow-up with imaging tests.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">In the literature reviewed regarding additional therapies to surgery, we found no obvious scientific evidence for the use of additional therapies in MASO, although some authors defend radiotherapy or systemic treatments in localized or advanced cases, regardless of whether the diagnosis is MA or MASO.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9–11</span></a> They choose chemotherapeutic schemes used for the treatment of uterine sarcomas, including doxorubicin, iphosphamide or gemcitabine/docetaxel.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,5,9,10</span></a> In summary, the management is controversial, partly due to the scarcity of published cases. In any case, treatment needs to be individualized.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,4,9,14</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0245" class="elsevierStylePara elsevierViewall">MA is a rare entity with a good prognosis. Cases with HE and SO are even more infrequent, but present a marked worsening in prognosis.</p><p id="par0250" class="elsevierStylePara elsevierViewall">An adequate sampling is imperative for a good diagnosis in order to identify the areas of SO, HE, myometrial invasion and to rule out epithelial malignancy.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Management beyond surgery is controversial in cases with poor prognostic factors and therefore it is necessary to perform more studies in this regard.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Author's contribution</span><p id="par0260" class="elsevierStylePara elsevierViewall">RA made the diagnosis and wrote the main manuscript. DBG assisted to the writing and prepared the figures and table. RB, MV and BS helped in the diagnosis process. RV and AL assisted in preparing, correcting the paper and looking for the most appropriate journal. CL was the patient's surgeon and met with the patient to obtain her informed consent for publication. RD is the head of department and reviewed the diagnosis in the initial stage.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethics declarations</span><p id="par0265" class="elsevierStylePara elsevierViewall">The study was approved by ethical approval, for this case report it was granted by the research ethics committee of University Hospital Donostia. Informed written consent was obtained from the patient and the data were used only for this case report.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Consent for publication</span><p id="par0270" class="elsevierStylePara elsevierViewall">Informed written consent was obtained from the patient for publication of this case report and accompanying images.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Availability of data and materials</span><p id="par0275" class="elsevierStylePara elsevierViewall">Samples stored in the Anatomical Pathology departments were collected for diagnostic purposes to promote and ensure the health of patients and not for an experimental procedure on patients.</p><p id="par0280" class="elsevierStylePara elsevierViewall">The raw data contains patient's names, phone numbers and family addresses. According to our informed consent, we may not publish the raw data which may reveal the personal information of the patient. However, data are available from the corresponding author on reasonable request.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0285" class="elsevierStylePara elsevierViewall">The authors declare that no funds, grants or other support were received during the preparation of this manuscript.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0290" class="elsevierStylePara elsevierViewall">The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2198507" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1845277" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2198506" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1845278" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Author's contribution" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethics declarations" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Consent for publication" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Availability of data and materials" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interests" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-01-16" "fechaAceptado" => "2024-03-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1845277" "palabras" => array:5 [ 0 => "Uterine mullerian adenosarcoma" 1 => "Sarcomatous overgrowth" 2 => "Heterologous elements" 3 => "Case report" 4 => "Literature review" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1845278" "palabras" => array:5 [ 0 => "Adenosarcoma mülleriano de útero" 1 => "Sobrecrecimiento sarcomatoso" 2 => "Elementos heterólogos" 3 => "Informe de caso" 4 => "Revisión bibliográfica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Uterine mullerian adenosarcoma (MA) is a rare biphasic tumour that accounts for less than 0.5% of uterine neoplasms. The age range of presentation is wide, with the median age in the 5th decade of life. It usually has a good prognosis; however, it worsens when it presents with sarcomatous overgrowth, heterologous elements or infiltrates the myometrium.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report the case of a 63-year-old woman presenting with abnormal vaginal bleeding and a sensation of solid material coming out of the cervical canal who was diagnosed with mullerian adenosarcoma with sarcomatous overgrowth (MASO) and presence of heterologous elements after performing a mass biopsy and subsequent hysterectomy.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We reviewed the literature, focusing especially on the differential diagnoses to be evaluated, as well as the differences in prognosis and treatment according to whether or not they present histologic features of poor prognosis.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El adenosarcoma mülleriano (AM) de útero es un raro tumor bifásico que representa menos del 0,5% de las neoplasias de útero. La edad de presentación es amplia, estando la mediana de la edad en la 5.ª década de vida. Normalmente tiene un buen pronóstico; sin embargo, empeora cuando se presenta con sobrecrecimiento sarcomatoso, elementos heterólogos o infiltra el miometrio.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comunicamos el caso de una mujer de 63 años, con sangrado vaginal anómalo y una sensación de salida de material sólido por el canal cervical. Se le diagnosticó adenosarcoma mülleriano con sobrecrecimiento sarcomatoso (AMSS) y presencia de elementos heterólogos después de realizar una biopsia de masa y posterior histerectomía.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Realizamos una revisión bibliográfica, centrándonos especialmente en los diagnósticos diferenciales a evaluar, así como en las diferencias en el pronóstico y en el tratamiento según si presentaban características histológicas de mal pronóstico o no.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1868 "Ancho" => 2007 "Tamanyo" => 762256 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Exophytic lesion with hypercellular stroma and broad-based phyllodes-like projections (A, haematoxylin–eosin (H–E) 10×), double component, epithelial and stromal. (B, H–E 20×) and atypical stromal cells arranged in a dense “cuffing” around the bland epithelial glands (C, H–E 40×).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 564 "Ancho" => 1674 "Tamanyo" => 326293 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sarcomatoid stroma with severe pleomorphism and anisonucleosis (A, H–E 100×) and heterologous rhabdoid elements (B, H–E 400×).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1434 "Ancho" => 2007 "Tamanyo" => 796056 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Oestrogen receptors (A, IHC 40×), CD10 (B. IHC 100×), MYO-D1 in the rhabdoid component (C, IHC 40×) and SMARCA4 (D, IHC 40×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mullerian adenosarcoma of the uterus – a clinicopathological analysis of ten cases of a distinctive type of mullerian mixed tumour" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.B. Clement" 1 => "R.E. Scully" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(197410)34:4<1138::aid-cncr2820340425>3.0.co;2-9" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1974" "volumen" => "34" "paginaInicial" => "1138" "paginaFinal" => "1149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4371193" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uterine mullerian adenosarcoma with sarcomatous overgrowth fatal recurrence within two weeks of diagnosis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.H. Farhat" 1 => "E.M. Hobeika" 2 => "G. Moumneh" 3 => "A.H. Nassar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1752-1947-1-103" "Revista" => array:5 [ "tituloSerie" => "J Med Case Rep" "fecha" => "2007" "volumen" => "1" "paginaInicial" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17894881" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uterine adenosarcoma: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Nathenson" 1 => "V. Ravi" 2 => "N. Fleming" 3 => "W.L. Wang" 4 => "A. Conley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11912-016-0552-7" "Revista" => array:5 [ "tituloSerie" => "Curr Oncol Rep" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27718181" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High grade uterine adenosarcoma with sarcomatous overgrowth in a young woman amenable to primary surgical reduction: a case study and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.D. Dowding" 1 => "L.M. Wayne" 2 => "A.S. Guirguis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gore.2021.100920" "Revista" => array:5 [ "tituloSerie" => "Gynecol Oncol Rep" "fecha" => "2021" "volumen" => "39" "paginaInicial" => "100920" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35036509" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case report: uterine adenosarcoma with sarcomatous overgrowth and malignant heterologous elements" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.I. García-Mendoza" 1 => "M. Murguia-Perez" 2 => "A.I. Galván-Linares" 3 => "S. Mendoza-Ramírez" 4 => "N.L. García-Salinas" 5 => "J.G. Moctezuma-Ramírez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fmed.2021.819141" "Revista" => array:4 [ "tituloSerie" => "Front Med" "fecha" => "2022" "volumen" => "8" "paginaInicial" => "819141" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mullerian adenosarcoma of uterus with sarcomatous overgrowth and heterologous component associated with stromal deposit in omentum: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Sinha" 1 => "J.P. Phukan" 2 => "S. Sengupta" 3 => "P. Guha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2012/820378" "Revista" => array:5 [ "tituloSerie" => "Case Rep Med" "fecha" => "2012" "volumen" => "2012" "paginaInicial" => "820378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22952480" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uterine adenosarcoma with sarcomatous overgrowth and rhabdoid features: a rare case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Rashid" 1 => "M. Akhtar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/sjmms.sjmms_315_21" "Revista" => array:7 [ "tituloSerie" => "Saudi J Med Med Sci" "fecha" => "2022" "volumen" => "10" "paginaInicial" => "72" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35283707" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1542356519304276" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SMARCA4 inactivation defines a subset of undifferentiated uterine sarcomas with rhabdoid and small cell features and germline mutation association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.I. Lin" 1 => "J.M. Allen" 2 => "J.L. Hecht" 3 => "J.K. Killian" 4 => "N.T. Ngo" 5 => "C. Edgerly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41379-019-0303-z" "Revista" => array:5 [ "tituloSerie" => "Mod Pathol" "fecha" => "2019" "volumen" => "32" "paginaInicial" => "1675" "paginaFinal" => "1687" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of uterine adenosarcomas with and without sarcomatous overgrowth" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.J. Tanner" 1 => "T. Toussaint" 2 => "M.M. Leitao Jr." 3 => "M.L. Hensley" 4 => "R.A. Soslow" 5 => "G.J. Gardner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ygyno.2012.12.036" "Revista" => array:6 [ "tituloSerie" => "Gynecol Oncol" "fecha" => "2013" "volumen" => "129" "paginaInicial" => "140" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23283300" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Uterine adenosarcoma with sarcomatous overgrowth versus uterine carcinosarcoma: comparison of treatment and survival" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.C. Krivak" 1 => "J.D. Seidman" 2 => "J.W. McBroom" 3 => "P.J. MacKoul" 4 => "L.M. Aye" 5 => "G.S. Rose" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1006/gyno.2001.6334" "Revista" => array:6 [ "tituloSerie" => "Gynecol Oncol" "fecha" => "2001" "volumen" => "83" "paginaInicial" => "89" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11585418" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Targeted genomic analysis of Müllerian adenosarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.E. Howitt" 1 => "L.M. Sholl" 2 => "P.D. Cin" 3 => "Y. Jia" 4 => "L. Yuan" 5 => "L. MacConaill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/path.4442" "Revista" => array:6 [ "tituloSerie" => "J Pathol" "fecha" => "2015" "volumen" => "235" "paginaInicial" => "37" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25231023" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Müllerian adenosarcomas of the uterus with sarcomatous overgrowth A clinicopathological analysis of 10 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Clement" 1 => "B.M.D. Philip" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-198901000-00004" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1989" "volumen" => "13" "paginaInicial" => "28" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2535774" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO Classification of Tumours Editorial Board. Female Genital Tumours. WHO Classification of Tumours. International Agency for Research on Cancer. 5th ed. 2020; ISBN 978-92-832-4504-9." ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case Report. Uterine adenosarcoma: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Q. Wang" 1 => "S. Sun" 2 => "J. Cai" 3 => "L. Yang" 4 => "L. Gang" 5 => "Q. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Nucl Med Mol Imaging" "fecha" => "2023" "volumen" => "13" "paginaInicial" => "70" "paginaFinal" => "77" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adenosarcoma of uterus with sarcomatous overgrowth and rhabdomyoblastic differentiation – a rare pathological entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Sharma" 1 => "Prachi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Exp Pathol" "fecha" => "2021" "volumen" => "2" "paginaInicial" => "42" "paginaFinal" => "46" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16998855/0000005700000003/v1_202407050618/S1699885524000370/v1_202407050618/en/main.assets" "Apartado" => array:4 [ "identificador" => "7944" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/16998855/0000005700000003/v1_202407050618/S1699885524000370/v1_202407050618/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699885524000370?idApp=UINPBA00004N" ]
Journal Information
Original
Müllerian adenosarcoma with sarcomatous overgrowth and heterologous elements: A case report and literature review
Adenosarcoma mülleriano con sobrecrecimiento sarcomatoso y elementos heterólogos: informe de caso y revisión bibliográfica