Original ArticlesMesodermal (Müllerian) Adenosarcoma of the Ovary: A Clinicopathologic Analysis of 40 Cases and a Review of the LiteratureEichhorn, John H. M.D.; Young, Robert H. M.D.; Clement, Philip B. M.D.; Scully, Robert E. M.D.Author Information From the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, and the Department of Pathology (J.H.E., R.H.Y., R.E.S.), Harvard Medical School, Boston, Massachusetts, U.S.A.; and the Departments of Pathology (P.B.C.), Vancouver General Hospital and Health Sciences Center and the University of British Columbia, Vancouver, British Columbia, Canada. This study was presented in part at the 88th annual meeting of the United States and Canadian Academy of Pathology, San Francisco, CA, USA, March 1, 1999. Address correspondence and reprint requests to John H. Eichhorn, MD, Warren 105C, Massachusetts General Hospital, 32 Fruit St., Boston, MA 02114, U.S.A.; e-mail: email@example.com The American Journal of Surgical Pathology: October 2002 - Volume 26 - Issue 10 - p 1243-1258 Buy SDC Abstract Forty cases of mesodermal adenosarcoma of the ovary occurred in women 30–84 years of age (mean 54 years). Abdominal discomfort and distension were the usual complaints. All the patients were treated with an oophorectomy, which was accompanied by a hysterectomy in 85%, a contralateral oophorectomy in 65%, and nonsurgical therapy in 28%. Tumor rupture occurred at or before the operation in 67% of the cases. Twenty-six tumors were stage I, 11 stage II, and 3 stage III. The tumors were unilateral in 97.5% of the cases and 5.5–50 cm (mean 14 cm) in greatest dimension; most of the tumors were predominantly solid but contained numerous small cysts. Microscopic examination revealed sarcomatous overgrowth in 12 tumors. Sex cord-like elements were present in six tumors (including four with sarcomatous overgrowth) and heterologous elements in five (including two with sarcomatous overgrowth). The highest mitotic index of the sarcomatous component was 1–25 (mean 6) mitotic figures per 10 high power fields. Only 6 of 26 women (23%) who were followed postoperatively for ≥5 years were free of tumor. In the other 20 patients recurrent tumor appeared at 0.4–6.6 years (mean 2.6 years) after operation as pure sarcoma (low grade or high grade) or adenosarcoma (with or without sarcomatous overgrowth). Eight women had additional recurrences, and four women had blood-borne metastases. One patient was alive at 15.7 years after the excision of pulmonary metastases. The 5-, 10-, and 15-year survival rates were 64%, 46%, and 30%, respectively. Age <53 years, tumor rupture, a high grade, and the presence of high-grade sarcomatous overgrowth appeared to be associated with recurrence or extraovarian spread. Ovarian adenosarcomas have a worse prognosis than uterine adenosarcomas, presumably because of the greater ease of peritoneal spread. Many of the tumors caused problems in differential diagnosis. © 2002 Lippincott Williams & Wilkins, Inc.