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Low grade endometrial stromal sarcoma: a case report.

Jain R, Batra S, Ahmad A, Elahi AA, Gupta M, Saith P - Iran J Med Sci (2015)

Bottom Line: Polypectomy followed by pan hysterectomy was performed.Histopathological examination and immunohistochemistry confirmed LGESS.In our case, we tried a different post-surgical protocol and the patient is being closely followed up.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India.

ABSTRACT
Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40-50 years. We report a case of low-grade ESS in a 39-year-old woman, presenting as rapid enlargement of a uterine fibroid polyp associated with irregular and excessive vaginal bleeding. Polypectomy followed by pan hysterectomy was performed. Histopathological examination and immunohistochemistry confirmed LGESS. As the tumor is rarely encountered, management protocols are still questionable. In our case, we tried a different post-surgical protocol and the patient is being closely followed up. Although rare, ESS should be considered in the differential diagnosis of all women who present with a rapid enlargement of a uterine leiomyoma.

No MeSH data available.


Related in: MedlinePlus

Endometrial stromal cells positive for CD-10 stain (internal control).
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Figure 2: Endometrial stromal cells positive for CD-10 stain (internal control).

Mentions: Her last childbirth was 11 years back and she was ligated. The patient was pale and hemoglobin (Hb) was 6 gm%. Vitals were stable and systemic examination was unremarkable. On speculum examination, a large retort shaped shaggy mass about 3 inches in diameter was seen coming out through os. On vaginal examination, the mass was felt as firm, globular and filling vagina in its upper part. Cervical rim felt all around the pedicle was high up. Uterus was 8 weeks in size, soft, anteverted. Bilateral fornices were clear. Pelvic ultrasound (USG) showed a cervical mass lesion with well-defined outline 9×8×8 cm, with heterogeneous echo pattern and multiple hyperechoic lesions in it. Endometrial cavity was pushed anteriorly. Uterus was bulky, bilateral adnexa were normal. Mild hydronephrotic changes were present in the left kidney. An impression of cervical leiomyoma was made. One unit of blood was transfused preoperatively and cervical polypectomy with endometrial curettage was done. The polyp was friable, globular and had a ragged appearance. It measured around 6.0×5.5×4.0 cm. Cut section showed a fleshy greyish pink appearance. On HPE, a differential diagnosis of ESN and LGESS was made and the patient was posted for laparotomy. Uterus was enlarged to 8 weeks size and soft in consistency. Bilateral ovaries were cystic as shown in figure 1). Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Pelvic lymph nodes were not enlarged. There were no metastases in the abdomen or extension in the broad ligament. Cut section revealed a nodular vascular mass 3.5×4.0 cm inside the endometrial cavity. Diffuse nodularity was present in entire myometrium. HPE and immunohistochemistry with CD10 (figure 2 and 3) confirmed the diagnosis of LGESS. According to the new 2009 FIGO Staging, it was stage IB disease. Postoperative period was uneventful and the patient was discharged after 5 days.


Low grade endometrial stromal sarcoma: a case report.

Jain R, Batra S, Ahmad A, Elahi AA, Gupta M, Saith P - Iran J Med Sci (2015)

Endometrial stromal cells positive for CD-10 stain (internal control).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300487&req=5

Figure 2: Endometrial stromal cells positive for CD-10 stain (internal control).
Mentions: Her last childbirth was 11 years back and she was ligated. The patient was pale and hemoglobin (Hb) was 6 gm%. Vitals were stable and systemic examination was unremarkable. On speculum examination, a large retort shaped shaggy mass about 3 inches in diameter was seen coming out through os. On vaginal examination, the mass was felt as firm, globular and filling vagina in its upper part. Cervical rim felt all around the pedicle was high up. Uterus was 8 weeks in size, soft, anteverted. Bilateral fornices were clear. Pelvic ultrasound (USG) showed a cervical mass lesion with well-defined outline 9×8×8 cm, with heterogeneous echo pattern and multiple hyperechoic lesions in it. Endometrial cavity was pushed anteriorly. Uterus was bulky, bilateral adnexa were normal. Mild hydronephrotic changes were present in the left kidney. An impression of cervical leiomyoma was made. One unit of blood was transfused preoperatively and cervical polypectomy with endometrial curettage was done. The polyp was friable, globular and had a ragged appearance. It measured around 6.0×5.5×4.0 cm. Cut section showed a fleshy greyish pink appearance. On HPE, a differential diagnosis of ESN and LGESS was made and the patient was posted for laparotomy. Uterus was enlarged to 8 weeks size and soft in consistency. Bilateral ovaries were cystic as shown in figure 1). Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Pelvic lymph nodes were not enlarged. There were no metastases in the abdomen or extension in the broad ligament. Cut section revealed a nodular vascular mass 3.5×4.0 cm inside the endometrial cavity. Diffuse nodularity was present in entire myometrium. HPE and immunohistochemistry with CD10 (figure 2 and 3) confirmed the diagnosis of LGESS. According to the new 2009 FIGO Staging, it was stage IB disease. Postoperative period was uneventful and the patient was discharged after 5 days.

Bottom Line: Polypectomy followed by pan hysterectomy was performed.Histopathological examination and immunohistochemistry confirmed LGESS.In our case, we tried a different post-surgical protocol and the patient is being closely followed up.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India.

ABSTRACT
Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40-50 years. We report a case of low-grade ESS in a 39-year-old woman, presenting as rapid enlargement of a uterine fibroid polyp associated with irregular and excessive vaginal bleeding. Polypectomy followed by pan hysterectomy was performed. Histopathological examination and immunohistochemistry confirmed LGESS. As the tumor is rarely encountered, management protocols are still questionable. In our case, we tried a different post-surgical protocol and the patient is being closely followed up. Although rare, ESS should be considered in the differential diagnosis of all women who present with a rapid enlargement of a uterine leiomyoma.

No MeSH data available.


Related in: MedlinePlus