Fig. 1: Histomorphologic spectrum of Mullerian adenosarcomas.

A MA04 (no specific genetic alterations), exhibiting characteristic leaf-life architecture; (B) MA7 (ESR1-NCOA3 fusion), bland fibroblastic-like stroma with low-grade nuclear features. C, D MA22 (TP53-mutated), high-grade adenosarcoma with sarcomatous overgrowth. The tumor shows rhabdomyosarcomatous heterologous elements and marked nuclear pleomorphism with prominent nucleoli and increased mitotic activity. E, F MA27 (DICER1-mutated), a predominantly low-grade adenosarcoma (E) with focal area showing enlarged, hyperchromatic nuclei with irregular borders and increased mitotic activity, but lacking significant nuclear pleomorphism, and therefore, classified as indeterminate grade (F). No heterologous elements were present. G–I MA17 (DICER1-mutated), focal areas exhibit fibroblastoid morphology and architectural features of adenosarcoma (G), with area in box shown at higher magnification to highlight cytologic features (H); other areas of this tumor show sarcomatous overgrowth comprised of sheets of primitive cells, consistent with a heterologous embryonal rhabdomyosarcoma component (I).