Endometrioid stromal sarcomas arising from ovarian and extraovarian endometriosis: Report of two cases and review of the literature

Baiocchi, G.; Kavanagh, John J.; Wharton, J. Taylor

doi:10.1016/0090-8258(90)90126-6

Cited by 57 publications

(44 citation statements)

References 14 publications

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“…Thirty seven cases were documented as associated with endometriosis. 2,4,8,10 It seems from theliterature and from our case that ESS is closely related to endometriosis and represents an exceedingly rare complication ofthat common disease. Our patient presented with abdominal and back pain, constipation, a pelvic mass and ascites.…”

Section: Discussionmentioning

confidence: 98%

“…7,8,10 The role of hormonal therapy is well documented in these low grade tumors. 1,2,5,7,8 Steroid receptor detection by immunohistochemistry is valuable. It was also noted that tumors that expressed both estrogen and progesteronereceptors have benefited from progesterone therapy; especially low grade tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Only 86 cases have been reported in the literature. 2,4 More than 50% of the cases were associated with pre-existing endometriosis. We report a case ofextrauterine low grade ESS associated with extensive endometriosis of the pelvis.…”

mentioning

confidence: 99%

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Multi-Focal Extra-Uterine Endometrial Stromal Sarcoma (ESS): A Very Rare Complication of Endometriosis Associated with Elevated Serum CA-125

et al. 2003

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Endometrial stromal sarcomas (ESS) in the female genital tract are uncommon and are usually of uterine origin.1,2,3 Extra-uterine ESS are extremely rare. Only 86 cases have been reported in the literature. 2,4 More than 50% of the cases were associated with pre-existing endometriosis. We report a case ofextrauterine low grade ESS associated with extensive endometriosis of the pelvis. We suspected that the tumor was a primary ovarian carcinoma due to elevated serum CA-125. Case ReportThe patient was a 45-year old premenopausal, multi-parous female (8 + 2). The patient presented with lower abdominal pain of 6 months duration associated with nausea and constipation.Her medical history included myomectomy for leiomyomas 17 years prior to this presentation. The patient was diabetic and hypertensive. Physical examination revealed a mass in the abdominal-pelvic region measuring 15 x 12 centimeters. Serum CA-125 was three times the normal range (197 mmol/L). Abdominal pelvic ultrasonography revealed an abdomino-pelvic mass of mixed echogenecity measuring 13x13 centimeters and located on the right side of the pelvis. The uterus was normal in size. A CT scan of the abdomen and pelvis showed a large heterogenouspelvi-abdominal mass with the epicenter in the region of the pelvic wall (Figure 1). The mass appeared adherent to the uterus and bowel wall. Laparotomy was performed and a mass adherent to the fundus of the uterus, the pelvic cul-de-sac and the bowel was found. There were multiple variable-sized nodules found in the wall of the pelvis, fallopian tubes and pelvic peritoneum. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with debulking was performed. The patient was given progesterone therapy (Megace R ) and was discharged. Grossly the tumor was composed of multiple yellow-tan fleshy nodules with focal cystic areas. Focal areas of hemorrhage and necrosis were identified. The tumor was near the right adnexa. The uterus, fallopian tubes andovaries showed multiple tumor nodules. Microscopically, the tumor consisted of diffuse sheets of small closely packed cells with uniform round oval nuclei with coarse, evenly dispersed chromatin and small inconspicuous nucleoli. The cytoplasm was scanty and its boundaries were not well defined. A distinct vascular pattern was identified (Figure 2). This pattern was more prominent on the reticulin stain (Figure 3). Mitotic figures were less than 1 in 10 /high power field. No cellular atypia or pleomorphism were identified. The tumor was strongly positive for estrogen and progesterone receptors (Figure 4). Multiple deposits of the tumor were identified in the omentum. The ovaries and tubes showed multiple foci of tumor and endometriosis ( Figure 5). The endometrium showed cystic hyperplasia without evidence of ESS.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Multi-Focal Extra-Uterine Endometrial Stromal Sarcoma (ESS): A Very Rare Complication of Endometriosis Associated with Elevated Serum CA-125

et al. 2003

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“…Therefore, ESS may originate from endometriosis or from metaplasia of the pelvic Müllerian cells (62). Among patients with ESS of ovarian origin, 11% were reported to have succumbed to disease, compared to 38% of patients with ESS of extraovarian origin, suggesting that extraovarian origin indicates a poor prognosis (63).…”

Section: Endometrial Stromal Sarcomamentioning

confidence: 99%

Identification of multiple pathways involved in the malignant transformation of endometriosis (Review)

et al. 2012

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Abstract. The association between endometriosis and malignant transformation has often been described in the medical literature. A search was conducted between 1966 and 2010 through the English language literature (online Medline PubMed database) using the keywords endometriosis combined with malignant transformation. The search revealed an increase in reports describing endometriosis and malignancy. Approximately 1.0% of women with endometriosis have lesions that undergo malignant transformation. The malignant processes that are associated with endometriosis may be classified into three groups: i) epithelial ovarian cancers (endometrioid adenocarcinoma and clear cell carcinoma), ii) other Müllerian-type tumors, including Müllerian-type mucinous borderline tumor and serous borderline tumor and iii) sarcomas such as adenosarcoma and endometrial stromal sarcoma in the female pelvic cavity. Persistent oxidative stress induced by endometriosis-dependent hemorrhage may be associated with carcinogenesis. In conclusion, the malignant transformation of endometriosis has multiple pathways of development and may share a common pathogenic mechanism; iron-induced oxidative stress derived from repeated hemorrhage.

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“…Sarcomas are the second and third most frequent endometriosis-associated extraovarian and ovarian tumors, respectively. Adenosarcoma and endometrial stromal sarcoma are the major histological types of sarcomas (Baiocchi, 1990;Heaps, 1990;Slavin, 2000). At least partially, differences in the incidences of tumor types (carcinoma versus sarcoma) depend on the tumor site, and further studies are needed to elucidate this mechanism.…”

Section: Histological Characteristics Of Endometriosis-associated Malmentioning

confidence: 99%

Endometriosis-Associated Ovarian Cancer: The Role of Oxidative Stress

Yamashita¹,

Toyokuni²

2012

Endometriosis - Basic Concepts and Current Research Trends

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Endometrioid stromal sarcomas arising from ovarian and extraovarian endometriosis: Report of two cases and review of the literature

Cited by 57 publications

References 14 publications

Multi-Focal Extra-Uterine Endometrial Stromal Sarcoma (ESS): A Very Rare Complication of Endometriosis Associated with Elevated Serum CA-125

Multi-Focal Extra-Uterine Endometrial Stromal Sarcoma (ESS): A Very Rare Complication of Endometriosis Associated with Elevated Serum CA-125

Identification of multiple pathways involved in the malignant transformation of endometriosis (Review)

Endometriosis-Associated Ovarian Cancer: The Role of Oxidative Stress

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