Malignant Potential of Endometrial Stromal Tumor With Limited Infiltration

Su, Ting-Fu; Chao, Tai-Kuang; Lee, Herng‐Sheng; Perng, Cherng‐Lih; Nieh, Shin

doi:10.1177/1066896913506934

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…Su et al. have reported cases of ESN with infiltration potential ( 27 ). It is possible that our patient was an LG-ESS patient 7 years ago or had ESN with infiltration potential; the metastases of the heart and large vessels were due to recurrence of LG-ESS or ESN with infiltration potential.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Low-grade endometrial stromal sarcoma with intravenous and intracardiac extension: a case after misdiagnosis of endometrial stromal nodule as submucosal fibroid

Chai,

Tao,

Ding

et al. 2023

Front. Oncol.

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We present herein a rare case of large vascular and cardiac metastases of low-grade endometrial stromal sarcoma (LG-ESS) in a female patient, which occurred after misdiagnosis of endometrial stromal nodule (ESN) as submucosal leiomyoma 7 years ago. Preoperative three-dimensional CT reconstruction was used to assess the extent of the lesion. The patient underwent radical resection: thrombectomy and total hysterectomy with bilateral salpingo-oophorectomy without establishing the cardiopulmonary bypass. Intraoperative transesophageal ultrasound (TEE) was used to monitor whether the intracardiac mass was removed completely. To date, this patient is alive without any evidence of recurrence 3 years after surgery. The differential diagnosis of ESN and LG-ESS is often difficult. A clear distinction can only be reliably made after histological analysis of the tumor’s entire interface with the neighboring myometrium. This case highlights that follow-ups of patients with ESN are important. Regular follow-up can detect metastasis and recurrence of misdiagnosed LG-ESS as early as possible. Distant metastasis of LG-ESS is rare, especially involving large vessels or the heart. The treatment should largely rely on multidisciplinary cooperation. Although the surgery is traumatic, the perioperative mortality rate is low, and patients can avoid death from congestive heart failure or sudden death.

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Section: Discussionmentioning

confidence: 99%

Case Report: Low-grade endometrial stromal sarcoma with intravenous and intracardiac extension: a case after misdiagnosis of endometrial stromal nodule as submucosal fibroid

Chai,

Tao,

Ding

et al. 2023

Front. Oncol.

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“…Hysterectomy is the gold standard in cases with ESN and low-grade endometrial stromal tumors, considering their theoretic ability to infiltrate and become malignant [ 3 ]. Until now, no immunohistochemical biomarker has proven to be able to distinguish benign nodules from potential malignant sarcomas prior to hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The 2014 WHO classification scheme incorporates recent molecular findings into the classification, dividing ESTs into endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma (HGESS), and undifferentiated uterine sarcoma (UUS) [ 1 ] based on their histological appearance. However, the differentiation between the subtypes is difficult [ 2 , 3 ] in specimens obtained after curettage. Furthermore, the prognosis varies from benign to invasive and malignant tumors.…”

Section: Introductionmentioning

confidence: 99%

Endometrial Stromal Nodule: A Rarity and a Pathological Challenge

Borg

Humaıdan

Noer

et al. 2015

Case Reports in Obstetrics and Gynecology

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Endometrial stromal tumors are rare, and endometrial stromal nodule is the least common. In the region of Middle Jutland, Denmark, only two cases are reported since 1995. The nodules are benign; nevertheless, hysterectomy is the treatment of choice. Tumor margins are required for diagnosis and essential to differentiate it from an invasive stromal sarcoma whose prognosis is very different. We report a rare case of a 38-year-old woman, with presurgical diagnosis of a uterine tumor/polyp. She presented with nausea and changes in bleeding pattern and initially had a transcervical polyp resection performed. Histopathological examination showed the presence of an endometrial stromal tumor with unclear margins, and an invasive malignant endometrial sarcoma could not be excluded. Pathological examination revealed an endometrial stromal nodule with invasion, not exceeding three mm. Endometrial stromal tumors are interesting due to their rare existence and difficulties in establishing a histological diagnosis. Although endometrial stromal nodules are benign entities, they must be differentiated from the other invasive malignant stromal tumors, which may change the final prognosis. No preoperative diagnostic tools are at hand, and benign as well as malignant tumors are treated with hysterectomy.

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“…The controversy is increased by the fact that some tumors are grossly circumscribed but show extensive microscopic myometrial invasion [3] and others with limited myometrial invasion have extrauterine disease [4]. In addition, there are reports of circumscribed tumors with myometrial invasion exceeding 3 mm [5]. Finally, some authors prefer terms such as finger-like projections or protrusions, rather than limited infiltration, emphasizing that such invasive foci should lack overt permeative growth, which also emphasizes the subjectivity of pathologic interpretation of these areas.…”

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confidence: 99%