High-Grade Cervical Müllerian Adenosarcoma with Sarcomatous Overgrowth and Heterologous Differentiation in an Adolescent Girl: A Rare Case Report and Literature Review
Mehsen Azizi, Rim Moubayed, Georges Ghaleb, Elias El Hajj, Philippe attieh, Lamia Azizi, Karam Karam, Anthony El SabbaghAbstract
Introduction
Müllerian adenosarcoma (MA) is a rare biphasic gynecologic malignancy composed of benign epithelial glands and malignant stromal elements. Cervical involvement is particularly uncommon, especially in pediatric and adolescent patients.
Case description
We report the case of a 13-year-old nulliparous girl who presented with a protruding vaginal mass and intermittent pelvic discomfort. Pelvic magnetic resonance imaging revealed a heterogeneous cervical mass involving the lower uterine segment with restricted diffusion suggestive of malignancy. Hysteroscopic examination demonstrated a large pedunculated polypoid lesion arising from the endocervix, and complete hysteroscopic excision was performed. Histopathological evaluation confirmed high-grade cervical Müllerian adenosarcoma with sarcomatous overgrowth and heterologous differentiation, including cartilaginous and focal rhabdomyosarcomatous elements.
Discussion
This case highlights the importance of considering cervical Müllerian adenosarcoma in the differential diagnosis of cervical polypoid masses in adolescents. Early histopathological diagnosis is essential, as high-risk features such as sarcomatous overgrowth and heterologous differentiation are associated with aggressive behavior and have important implications for treatment planning and long-term follow-up.