Müllerian adenosarcoma in a young adult: A case report and literature review of diagnostic and management challenges

Abstract

Background: Müllerian adenosarcoma is a rare biphasic uterine malignancy typically affecting postmenopausal women. Its occurrence in young, nulliparous women is extremely uncommon, presenting diagnostic challenges, especially in cases of presumed recurrences. Case Presentation: A 22-year-old nulliparous woman presented with a presumed recurrent, enlarging prolapsing uterine mass and post-coital bleeding. Her history was notable for two prior excisions of a similar mass without histopathological review. Examination revealed a 6 cm friable mass protruding through the cervical os. Given the recurrence and risk of hemorrhage in a resource-limited setting, a total abdominal hysterectomy was performed. Gross examination identified a 9x6x4 cm polypoid mass confined to the fundus. Histopathology confirmed high- grade endometrial adenosarcoma, characterized by classic biphasic features, significant spindle-cell atypia, and a brisk mitotic rate (>10 mitoses/10 HPFs). Immunohistochemistry showed stromal positivity for CD10 and PR. No myometrial invasion or lymphovascular space invasion was observed. The patient remains asymptomatic under a rigorous three-month surveillance protocol. Conclusion: This case highlights a rare high-grade presentation in a young adult. Despite aggressive histological features, the absence of myometrial invasion supports definitive surgery followed by intensive long-term sur veillance. This report underscores the necessity of a high index of suspicion for malignancy in recurrent polypoid masses within the reproductive age group and addresses critical gaps regarding fertility preservation and age- specific management protocols.