Lymphadenectomy and Ovarian Preservation in Low-Grade Endometrial Stromal Sarcoma

Shah, Jay P.; Bryant, Christopher S.; Kumar, Sanjeev; Ali-Fehmi, Rouba; Malone, John M.; Morris, Robert T.

doi:10.1097/aog.0b013e31818aa89a

Cited by 140 publications

(85 citation statements)

References 27 publications

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“…The problem with regard to earlier studies is that the various conditions were aggregated, preventing meaningful analysis of any single variable (6)(7)(8)(9)(10)(11)(12)(13). Further, some recent studies are still using the older classification (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) …”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Diagnostic Criteria Distinguishing Endometrial Stromal Sarcoma, Low Grade From Undifferentiated Endometrial Sarcoma, 2 Entities Within the Invasive Endometrial Stromal Neoplasia Family

Feng

Malpica

Robboy

et al. 2013

International Journal of Gynecological Pathology

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Summary:The World Health Organization (WHO 2003) recognizes 3 endometrial stromal neoplasms: noninvasive endometrial stromal nodule and the 2 invasive neoplasms, endometrial stromal sarcoma (ESS), low grade and undifferentiated endometrial sarcoma (UES). It is important to note that the WHO 2003 does not define moderate atypia (an important differentiating diagnostic criterion for ESS, low grade and UES), nor does it discuss its significance. Moreover, studies on reproducibility and additional prognostic value of other diagnostic features in large are lacking. Using strict definitions, we analyzed the agreement between routine and expert-review necrosis and nuclear atypia in 91 invasive endometrial stromal neoplasias (IESN). The overall 5-year and 10-year recurrence-free survival rate estimates of the 91 IESN patients were 82% and 75%, respectively. Necrosis was well reproducible, and nuclear atypia was reasonably well reproducible. The 10-year recurrence-free survival rates for necrosis absent/inconspicuous versus prominent were 89% and 45% (Po0.001) and those for review-confirmed none/mild, moderate, severe atypia were 90%, 30%, and o20% (Po0.00001). Therefore, cases with moderate/severe atypia should be grouped together. Nuclear atypia and necrosis had independent prognostic values (Cox regression). Once these features were taken into account, no other feature had an independent additional prognostic value, including mitotic count. Using ''none/

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Diagnostic Criteria Distinguishing Endometrial Stromal Sarcoma, Low Grade From Undifferentiated Endometrial Sarcoma, 2 Entities Within the Invasive Endometrial Stromal Neoplasia Family

Feng

Malpica

Robboy

et al. 2013

International Journal of Gynecological Pathology

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“…Thereafter annual follow up is recommended. Because of concern about radiation exposure, frequent routine asymptomatic surveillance imaging is not recommended after primary treatment 10 . The relapse free survival depends on the tumor stage, myometrial invasion, adjuvant treatment, and bilateral salpingoopherectomy 11,12 .…”

Section: Resultsmentioning

confidence: 99%

Rare case of aub in a postmenopausal women endometrial stromal sarcoma: A case report

Bhandari¹,

Bhati²

2014

Int J of Biomed & Adv Res

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A postmenopausal, 70 year old woman (P3) visited our O.P.D with complaints of heavy bleeding per vaginum since three months, which was not associated with any pelvic or abdominal pain. O/E-Abdomen was soft non tender and no mass could be felt. Per vaginum examinationOS admitted one finger; a smooth large polyp like structure felt arising from lateral wall of uterus filling the endometrial cavity and uterus was regularly enlarged to 12 weeks with b/l adnexa free.Her routine investigations (Hb, total leucocyte counts, total platelet counts, coagulation profile, renal function and liver function tests) were within normal limts. Transvaginal USGFindings revealed presence of a solitary solid intrauterine mass of about 7x8 cms with cystic changes? Leiomyoma. Endometrial thickness ET was 3mm.Her endometrial biopsy report was suggestive of Endometrial Stromal Sarcoma (ESS)CT SCAN findings negated any metastasis or lymphovascular invasion and showed the presence of a solid smooth mass in endometrial cavity of about 7.4x6x4cms. Subsequently after counselling & oncosurgical consultation the patient with high risk consent underwent TAH & BSO. Uterus was uniformly enlarged to about 12 wks size, external surface was smooth with no growth visible on the external surface and b/l adenexa normal for age. Cut section of the specimen revealed a smooth solitary ovoid mass in the endometrial cavity measuring appx 7x5 cms in dimensions and was free from all sides from myometrium except on the left where it was attached through its broad base. Cut section of growth showed fatty degeneration but absence of any whorled appearance.Histopathological report showed the presence of endometrial stromal sarcoma with less than 50% invasion of myometrium FIGO Stage IB There were evidences of micro invasions in the lymphovascular channels.Patient had uneventful recovery & was discharged on D6 postoperatively with advice to remain in follow up and consult medical oncologist for further treatment. AbstractEndometrial Stromal Sarcomas (ESSs) are very rare malignant tumors that constitute approximately 10% of all uterine sarcomas but only around 0.2% of all uterine malignancies. The annual incidence of ESS is 1-2 per million women. It is also known as endometrial stromal myosis. The median age was 44.35 ± 6 years. Women with ESS are younger than women with other uterine sarcomas, with a median age between 45 and 57 years and, generally do not have the usual risk factors for endometrial cancer. Reported cases of endometrial stromal sarcoma in a postmenopausal woman are a rare entity.These tumors are said to be hormone dependent and therefore seems to be more common in reproductive and perimenopausal age group. Patients mainly presents with complaints of heavy vaginal bleeding and pain abdomen. ESS can be mistaken for leiomyoma. Clinical and radiology findings are suggestive of a leiomyoma. HPE remains the mainstay for diagnosis of such tumors .As these tumors are known for their recurrences close follow up of these patients is very important.

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“…In addition, LG-ESS have high levels of steroid receptors and metastasize most frequently from the uterus to the ovaries. A Surveillance Epidemiology and End Results (SEER) analysis did not show any negative effects on overall survival when the ovaries were preserved in premenopausal patients [44]. The decision whether or not to preserve the ovaries therefore always needs to be critically discussed with the patient, with the potential advantage of preserving the ovaries being carefully weighed against the increased risk of recurrence.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Low-Grade Endometrial Stromal Sarcoma - a Review

Thiel¹,

Halmen²

2018

Oncol Res Treat

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Like other uterine sarcomas, low-grade endometrial stromal sarcomas (LG-ESS) are a very rare tumor entity. In the past, research studies therefore discussed the various different types of the disease in combination. In addition, the classification of endometrial stromal tumors presented difficulties for quite some time so that in earlier studies it was not always possible to precisely distinguish between LG-ESS, high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma. For LG-ESS, surgery with hysterectomy and adnexectomy is the first-line treatment. The benefits of lymphadenectomy and tumor debulking are unclear. Endocrine therapy with gestagens and aromatase inhibitors is under discussion to provide adjuvant treatment for patients with advanced stages of the disease. As radiotherapy only provides locoregional control, and in view of the usually good prognosis of patients with LG-ESS, its benefits need to be weighed against its side effects. In the case of recurrence, repeat surgery is the first choice. Further research studies viewing LG-ESS as a distinct entity are needed in order to improve treatment options for patients with LG-ESS.

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Lymphadenectomy and Ovarian Preservation in Low-Grade Endometrial Stromal Sarcoma

Abstract: II.

Cited by 140 publications

References 27 publications

Prognostic Value of the Diagnostic Criteria Distinguishing Endometrial Stromal Sarcoma, Low Grade From Undifferentiated Endometrial Sarcoma, 2 Entities Within the Invasive Endometrial Stromal Neoplasia Family

Prognostic Value of the Diagnostic Criteria Distinguishing Endometrial Stromal Sarcoma, Low Grade From Undifferentiated Endometrial Sarcoma, 2 Entities Within the Invasive Endometrial Stromal Neoplasia Family

Rare case of aub in a postmenopausal women endometrial stromal sarcoma: A case report

Low-Grade Endometrial Stromal Sarcoma - a Review

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