Low-Grade Uterine Adenosarcoma in a Postmenopausal Patient: A Case Report and Literature Review

Low-grade uterine adenosarcoma is a rare neoplasm accounting for 5.5–9 % of all uterine sarcomas. First described by Clement and Scully in 1974, it is characterized by benign endometrial glands combined with a low-grade malignant mesenchymal stroma. We report the case of a 77-year-old woman without known risk factors (endometriosis, hormonal therapy, or pelvic radiotherapy) who presented with intermittent metrorrhagia. Pelvic ultrasound and clinical examination revealed a uterine mass, and diagnostic hysteroscopy with polypectomy confirmed low-grade adenosarcoma (5 mitoses per 10 high-power fields, moderate stromal invasion). Pelvic MRI demonstrated a well-circumscribed lesion measuring 54 × 68 × 100 mm without deep myometrial invasion or dissemination. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy; the surgical specimen confirmed FIGO stage IB disease with positive estrogen and progesterone receptors. Following an uneventful postoperative course and a negative chest CT, adjuvant therapy with anastrozole 1 mg daily was initiated, and follow-up was scheduled every three months clinically and every six months with pelvic imaging. This case underscores the importance of precise histopathological diagnosis, long-term surveillance, and the potential benefit of adjuvant hormone therapy in the absence of sarcomatous overgrowth.