A Case of Deep Infiltrating Endometriosis Undergoing Malignant Transformation to Müllerian Adenosarcoma: Case Report and Literature Review.

Abstract

Müllerian adenosarcoma (MA) is a rare malignant tumor of the female reproductive system. Owing to the limited number of clinical cases and the absence of characteristic clinical manifestations, its clinical course remains poorly defined, resulting in ongoing uncertainties regarding the diagnosis and management of this disease. Herein, we report a case of pelvic MA confirmed by surgical and pathological evaluation at our institution. Clinical data of the patient were collected and, in conjunction with a literature review, the two-dimensional and color Doppler ultrasonographic features are summarized, with the aim of enhancing recognition of this disease and improving diagnostic accuracy. This case report presents a 37-year-old female with a left adnexal cystic mass, previously diagnosed with endometriosis, illustrating the potential malignant transformation into MA, a rare tumor arising from Müllerian ducts. The clinical manifestations of MA are often nonspecific, complicating diagnosis and potentially delaying treatment. This case emphasizes the need for heightened vigilance in patients with endometriosis, especially those exhibiting atypical symptoms or elevated tumor markers such as CA125. The relationship between chronic inflammation, hormonal influences, and neoplastic progression underscores the importance of continuous monitoring and a multidisciplinary approach that integrates clinical history, imaging studies, and laboratory findings. The rarity of MA and its overlapping imaging characteristics with other gynecological conditions further complicate its identification, necessitating further research to establish standardized diagnostic and management protocols. This report not only adds to the limited literature on MA but also serves as a critical reminder of the malignant potential associated with endometriosis, advocating for improved awareness and early intervention strategies to enhance patient outcomes in this vulnerable population.