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Dai Q, Xu B, Wu H, You Y, Li L. Prognosis of uterine and extrauterine low-grade endometrial stromal sarcoma: an observational cohort study. Int J Surg 2024; 110:1919-1928. [PMID: 38329091 PMCID: PMC11020013 DOI: 10.1097/js9.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Little is known about the survival differences between uterine and extrauterine low-grade endometrial stromal sarcoma (LGESS). Survival outcomes, consisting of disease-free survivals and overall survivals (OS), were compared in these two entities. METHODS From February 2012 to June 2019, all primary LGESS cases and LGESS cases with first recurrence in the study center were reviewed. The clinicopathological characteristics and survival outcomes of extrauterine and uterine LGESS patients were compared for both primary and recurrent diseases. RESULTS During the study period, 143 patients with primary LGESS and 56 patients with recurrent LGESS were included and followed up to 1 June 2020, among whom 8 (5.6%) and 10 (17.8%) patients were identified as having extrauterine LGESS. Patients with primary and recurrent extrauterine LGESS had similar clinicopathological characteristics to those of patients with uterine LGESS. In primary or in recurrent LGESS cases, in univariate analysis, patients with uterine and extrauterine LGESS had similar disease-free intervals after the last treatment, and they also had similar OSs after the diagnosis. Ovarian preservation led to significantly increased recurrence for primary LGESS [hazard ratio (HR) 4.9, 95% CI: 2.3-10.1, P <0.001) and repeated recurrence for recurrent LGESS (HR 3.1, 95% CI: 1.3-7.3, P =0.009). Surgical treatment for recurrent LGESS decreased repeated recurrence after the first recurrence (HR 0.2, 95% CI: 0.1-0.7, P =0.006). No factors were found to be associated with the OS of primary or recurrent LGESS. CONCLUSION The clinical characteristics and survival outcomes of extrauterine LGESS are similar to those of uterine LGESS. Surgery is the treatment of choice for recurrent LGESS. Ovarian preservation is detrimental to disease-free survival but not to OS in both uterine and extrauterine LGESS.
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Affiliation(s)
| | - Baolin Xu
- Department of Obstetrics and Gynecology
- Department of Obstetrics and Gynecology, the Second People’s Hospital of Jingdezhen, Jingdezhen, People’s Republic of China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital
| | - Lei Li
- Department of Obstetrics and Gynecology
- State Key Laboratory for Complex, Severe and Rare Diseases
- National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing
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2
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Extrauterine endometrial stromal sarcoma: A systematic review and outcome analysis. Ann Diagn Pathol 2022; 59:151966. [DOI: 10.1016/j.anndiagpath.2022.151966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
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3
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Sharma A, Bal M, Menon S. Extragenital endometrial stromal sarcoma of transverse mesocolon: A diagnostic conundrum. Int J Surg Pathol 2021; 30:551-556. [PMID: 34970922 DOI: 10.1177/10668969211070485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endometrial stromal sarcoma (ESS) is a rare uterine neoplasm infrequently arising in extra-genital sites. Herein, we report an extremely rare case of primary extra-genital ESS of transverse mesocolon occurring in a 51-year-old female presenting with gradually increasing abdominal mass. The clinical diagnosis considered was a gastrointestinal stromal tumor. Intra-operatively, the mass was confined exclusively to the transverse mesocolon. Microscopy revealed a cellular tumor composed of oval to elongate neoplastic cells with hyperchromatic nuclei, inconspicuous nucleoli and were immunoreactive for CD10, progesterone receptor (PR), estrogen receptor (ER), and PAX8; negative for KIT, CD34, SMA, S100, synaptophysin, chromogranin, WT-1, and calretinin. A distinct arborizing network of arterioles along with foci of endometriosis was also seen. We present this case for its extreme rarity and the challenges entailed in its diagnosis.
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Affiliation(s)
- Aishwarya Sharma
- Tata Memorial Hospital, Homi Bhabha National institute, Mumbai 400012, Maharashtra, India
| | - Munita Bal
- Tata Memorial Hospital, Homi Bhabha National institute, Mumbai 400012, Maharashtra, India
| | - Santosh Menon
- Tata Memorial Hospital, Homi Bhabha National institute, Mumbai 400012, Maharashtra, India
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4
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Endometrial stromal sarcoma of the sigmoid colon: a case report and literature review. Int Cancer Conf J 2021; 10:294-299. [PMID: 34567941 DOI: 10.1007/s13691-021-00493-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
Abstract
Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus that accounts for 7-25% of uterine sarcomas and < 1% of uterine tumors. Previously reported sites include the ovary, bowel wall, abdomen, peritoneum, pelvis, and vagina; however, ESS in the extrauterine area is rare. We report a rare case of endometrial stromal sarcoma that developed in the sigmoid colon along the gonadal vasculature, which was difficult to distinguish from colon cancer. A large polyp was found in the sigmoid colon of a 74-year-old woman during a routine medical examination and was diagnosed as tubular adenoma. On colonoscopy 7 months later, the tumor had grown and blocked the lumen, causing stenosis. She was referred to our hospital for surgery. Although detailed examination at our hospital did not yield a definitive diagnosis, bowel obstruction was considered likely and we performed laparoscopic low anterior resection under a preoperative diagnosis of sigmoid colon cancer. The tumor protruded into the sigmoid colon from the stump of the ovarian arteries and veins outside the intestinal tract. As the left ovarian artery and vein were involved in the tumor, we extracted them as a lump. The tumor was diagnosed as low-grade ESS (LG-ESS). She had a history of hysterectomy and left salpingo-oophorectomy for uterine myoma 25 years ago, and radiation therapy was performed after surgery for an unknown reason. The postoperative course was uneventful, and follow-up was continued at the request of the patient. We report a rare case of ESS infiltrating the sigmoid colon, which was probably a lesion derived from endometriosis of the ovarian arteriovenous stump remaining after surgery 25 years ago.
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Gupta S, Gupta P, Srinivasan R, Saha SC, Chopra S, Sikka P, Rajwanshi A. Disseminated Peritoneal Endometriosis Evolving to High-Grade Endometrial Stromal Sarcoma: A Case Report with Review of the Literature. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shruti Gupta
- Department of Cytology and Gynecologic Pathology, and Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, and Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, and Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Chandra Saha
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, and Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Kundu K, Kuhn T, Kohut A, Staley C, Hanley K, Khanna N. Primary colonic extrauterine endometrial stromal sarcoma: A case and review of the literature. Gynecol Oncol Rep 2020; 32:100578. [PMID: 32382649 PMCID: PMC7200303 DOI: 10.1016/j.gore.2020.100578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022] Open
Abstract
Primary colonic extrauterine endometrial stromal sarcoma is a rare entity and diagnosis of this tumor can be challenging. There is a common gene translocation specific to the tumors, our case was confirmed by identifying it. Classifying these tumors correctly is important for treatment.
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Affiliation(s)
- Kuhali Kundu
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, United States
| | - Theresa Kuhn
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, United States
| | - Adrian Kohut
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, United States
| | - Charles Staley
- Emory University School of Medicine, Department of Surgery, Division of Surgical Oncology, Atlanta, GA, United States
| | - Krisztina Hanley
- Emory University School of Medicine, Department of Pathology, Atlanta, GA, United States
| | - Namita Khanna
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Atlanta, GA, United States
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7
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Alessandrini L, Sopracordevole F, Bertola G, Scalone S, Urbani M, Miolo G, Perin T, Italia F, Canzonieri V. Primary extragenital endometrial stromal sarcoma of the lung: first reported case and review of literature. Diagn Pathol 2017; 12:36. [PMID: 28464838 PMCID: PMC5414122 DOI: 10.1186/s13000-017-0627-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/17/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Endometrial stromal sarcomas arising in extrauterine and extraovarian sites, in the absence of a primary uterine lesion are quite rare, especially in the absence of endometriosis. They usually present as an abdominal or pelvic mass lesion. CASE PRESENTATION In 2007, a 45-year-old woman underwent total hysterectomy for in situ squamous cell carcinoma of the cervix. In 2014, an upper left pulmonary lobectomy was performed for a mass, which was provisionally diagnosed as primary carcinosarcoma of the lung. A second histological revision of the lung surgical specimen was performed in the Pathology Unit of our Institute. After extensive immunohistochemical analyses, the preferred diagnosis was spindle-cell sarcoma, consistent with high-grade extragenital endometrial stromal sarcoma (EESS). A review of all slides of the hysterectomy specimen confirms the original diagnosis: no evidence of stromal tumor was found. Afterwards, the patient developed multiple and metachronous pulmonary lesions and a scapular soft tissue mass, which showed the same morphophenotypic features of the first lung mass. The patient was treated with antiblastic therapy, surgical resection and radioablation, when appropriate. To date, the patient has no signs or symptoms. CONCLUSIONS The authors present the first case of primary EESS arising in the lung with no association with endometriosis published to date. Detailed clinical history and follow-up are also described. Moreover, extensive literature review is reported, along with differential diagnoses, immunohistochemical and molecular findings, pathogenetic hypotheses and treatment options. The knowledge of EESS potential extrauterine location and of its peculiar morphophenotypic aspects are required for a correct diagnosis, and for choosing the most suitable treatment.
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Affiliation(s)
- Lara Alessandrini
- Pathology, IRCCS-National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy.
| | | | - Giulio Bertola
- Surgical Oncology, IRCCS-National Cancer Institute, Aviano, Italy
| | - Simona Scalone
- Department of Medical Oncology, IRCCS-National Cancer Institute, Aviano, Italy
| | - Martina Urbani
- Department of Radiology, IRCCS-National Cancer Institute, Aviano, Italy
| | - Gianmaria Miolo
- Department of Medical Oncology, IRCCS-National Cancer Institute, Aviano, Italy
| | - Tiziana Perin
- Pathology, IRCCS-National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy
| | | | - Vincenzo Canzonieri
- Pathology, IRCCS-National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy
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8
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Buchholz V, Kiroff G, Trochsler M, Kanhere H. An unexpected diagnosis of primary omental endometrial stromal sarcoma in a patient with acute right abdominal pain: A case report and review of literature. Int J Surg Case Rep 2017; 36:8-14. [PMID: 28494324 PMCID: PMC5425343 DOI: 10.1016/j.ijscr.2017.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/07/2017] [Accepted: 04/12/2017] [Indexed: 11/24/2022] Open
Abstract
Only case in literature without history of endometriosis, on Hormone replacement therapy. Only the second case with isolated omental lesion. Extrauterine Endometrial Stromal Sarcoma (EESS) is an extremely rare mesenchymal tumour. This condition can simulate chronic or acute abdominal pathologies. The tumour can occur without preceding endometriosis, and in upper abdominal location. Biopsy showing typical immunohistochemistry markers is the best way to achieve diagnosis. Hormone replacement therapy may be an independent risk factor for EESS occurrence.
Introduction Extrauterine Endometrial Stromal Sarcoma (EESS) is an extremely rare mesenchymal tumour that simulates other pathologies, and therefore poses a diagnostic challenge. This report outlines a case of EESS arising from the greater omentum mimicking a colonic tumour, with review of literature. Presentation of case A 47-year-old woman, with history of hysterectomy for menorrhagia and hormone replacement therapy (HRT), presented with right sided abdominal pain and localized peritonism. On exploratory laparoscopy an omental tumour, suspected to arise from the transverse colon was identified and biopsied. The histological features suggested an EESS. Colonoscopy ruled out colonic lesion. A laparoscopic tumour resection and bilateral salpingo-oophorectomy (BSO) was performed. Immunohistochemistry confirmed the diagnosis. No additional lesions or associated endometriosis were found. Resection was followed by adjuvant medroxyprogesterone-acetate therapy. Discussion We reviewed 20 cases of EESS originating from extragenital abdominopelvic organs reported since 1990. Acute presentation is rare, as well as upper abdominal occurrence. Isolated omental involvement was previously reported in only one case. Endometriosis is a risk factor for development of EESS and history and/or histological evidence for endometriosis is usually present. HRT is another acknowledged risk factor, mostly on the background of endometriosis. To our knowledge, this is the only report of EESS occurring in a woman on HRT treatment without background of endometriosis. Conclusion EESS can occur without endometriosis and HRT may be an aetiological factor. The condition can mimic a chronic or acute abdominal pathology and laparoscopic core biopsy is the best way to achieve a diagnosis and formulate management.
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Affiliation(s)
- Vered Buchholz
- Upper Gastorintestinal and Hepatobiliary Unit, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia.
| | - George Kiroff
- Upper Gastorintestinal and Hepatobiliary Unit, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Markus Trochsler
- Upper Gastorintestinal and Hepatobiliary Unit, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Harsh Kanhere
- Upper Gastorintestinal and Hepatobiliary Unit, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
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9
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Abstract
The malignant transformation of endometriosis is very uncommon. Whereas 75% of tumors arising from endometriosis arise in the ovary, location in extra-genital organs is rare and mesenchymal neoplasms are exceptional. A 47 year-old woman who underwent hysterectomy with bilateral salpingo-ooforectomy due to endometriosis 13 years before presented with abdominal pain. The magnetic resonance imaging (MRI) showed a 9.7×7.5 cm solid-cystic supravesical mass and a recto-vaginal tumor, as well as endometriotic nodules in the sigma, right parametrium and peritoneum that had significantly increased in size over a six months period. The patient underwent surgical resection of the masses. The histological study showed a low-grade endometrial stromal sarcoma (ESS) arising from endometriosis located at recotovaginal septum and affecting colonic wall and multiple peritoneal and pelvic implants. The patient received radiotherapy and aromatase inhibitors and is free of disease after a follow up of 2 years. Only 15 cases of ESS arising in endometriosis of the bowel have been reported. Tumor dissemination at diagnosis is unusual but does not imply a poor prognosis, as only one patient has died due to progression of the tumor. ESS should be included in the differential diagnosis of mesenchymal neoplasms in the intestine.
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10
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Endometrial stromal nodule of the vaginal wall with a review of vulvovaginal endometrial stromal neoplasms. Gynecol Oncol Rep 2015; 11:13-5. [PMID: 26076086 PMCID: PMC4434158 DOI: 10.1016/j.gore.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 11/11/2014] [Indexed: 11/20/2022] Open
Abstract
It is reported the first endometrial stromal nodule (ESN) in the vagina. This is an excepcionall ESN because it was not associated with endometriosis It was successfully treated by local resection. Primary vulvovaginal endometrial stromal neoplasms are rare (only 5 reported)
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11
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Son HJ, Kim JH, Kang DW, Lee HK, Park MJ, Lee SY. Primary extrauterine endometrial stromal sarcoma in the sigmoid colon. Ann Coloproctol 2015; 31:68-73. [PMID: 25960975 PMCID: PMC4422990 DOI: 10.3393/ac.2015.31.2.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/06/2015] [Indexed: 01/08/2023] Open
Abstract
An endometrial stromal sarcoma (ESS) is an uncommon uterine neoplasm, and its primary occurrence in the intestine as an extrauterine ESS (EESS) is exceedingly rare. We hereby report a primary EESS arising in the sigmoid colon with a review of the literature. A 52-year-old woman presented with bloody stool and underwent a colon fiberscopy, which revealed a fungating mass obstructing the lumen at the distal sigmoid. A laparoscopic low anterior resection was performed, and an umbilicated polypoid mass was identified; on section, it had infiltrated the mesocolic fat and measured 3.8 cm × 2.5 cm. The tumor showed geographic sheets or nests composed of relatively monotonous stromal cells, expansion or infiltration to the proper muscle and mesocolic fat, and extensive lymphovascular invasion and metastasis to regional lymph nodes and the pelvic peritoneum. The tumor cells were strongly and diffusely immunoreactive for CD10, but negative for c-kit, CD34, and Dog1. Two months later, a hysterectomy with a bilateral salpingo-oophorectomy was performed, and no evidence of an ESS was found in the uterus.
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Affiliation(s)
- Hyun-Jin Son
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Joo-Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Dong-Wook Kang
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hye-Kyung Lee
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Mee-Ja Park
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Seung Yun Lee
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
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12
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Endometrial stromal sarcoma arising in colorectal endometriosis: a case report and review of the literature. Case Rep Obstet Gynecol 2015; 2015:534273. [PMID: 25648532 PMCID: PMC4306220 DOI: 10.1155/2015/534273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 12/23/2014] [Indexed: 02/05/2023] Open
Abstract
Extrauterine endometrial stromal sarcoma (ESS) arising in endometriosis is extremely rare, particularly in the colorectum. It should always be included in the differential diagnosis of primary tumors originating from gastrointestinal tract in females, given that preoperative endoscopical biopsy may reveal no specific changes. We reported a case of ESS arising in colorectal endometriosis and reviewed the previous 7 cases reported in the English literature. Our patient, who was unavailable for tumor resection and refused further adjuvant therapy, played a role in representing the natural history of low-grade extragenital ESS. This case was the only death from ESS arising in colorectal endometriosis.
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13
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A case of extrauterine endometrial stromal sarcoma in the colon diagnosed three decades after hysterectomy for benign disease. Case Rep Obstet Gynecol 2013; 2013:202458. [PMID: 23710389 PMCID: PMC3655501 DOI: 10.1155/2013/202458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/04/2013] [Indexed: 12/04/2022] Open
Abstract
Extrauterine endometrial stromal sarcoma (ESS) is rare and typified by delayed recurrence of primary ESS. Here, we report an unusual case of colonic ESS in a woman with a remote history of hysterectomy. An 80-year-old woman, with a history of hysterectomy and bilateral salpingo-oophorectomy for abnormal bleeding and endometriosis 37 years prior to presentation, was diagnosed with ESS in the colon. She was treated with laparoscopic low anterior resection, followed by megestrol acetate, and has been in remission for more than 4 years. This case highlights the rarity of extra-uterine ESS in the colon, especially in the absence of a known history of primary uterine ESS. The patient's history of endometriosis may have been a predisposing risk factor. ESS in the colon may be treated successfully with surgical resection and progestin therapy. Indefinite surveillance is recommended to monitor for late recurrences.
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14
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Lan C, Huang X, Lin S, Cai M, Liu J. Endometrial stromal sarcoma arising from endometriosis: a clinicopathological study and literature review. Gynecol Obstet Invest 2012; 74:288-97. [PMID: 22986788 DOI: 10.1159/000341706] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 07/06/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We aimed to investigate the nature of endometrial stromal sarcoma (ESS) arising from endometriosis. METHODS The clinical data of 5 patients with ESS arising from endometriosis were reviewed retrospectively. The expression of CD117, HER2/neu, EGFR, VEGF, and PDGFR was analyzed by immunohistochemical staining. RESULTS The median age of the 5 patients was 45 years. The primary tumor sites were the ovary in 2, the pelvis in 2, and the cervical canal in 1 patient. Three patients had disseminated disease at diagnosis. Four patients underwent complete tumor resection. All of the 5 cases received adjuvant chemotherapy and 2 received progesterone therapy, while none were treated with radiotherapy. No recurrence occurred in the 4 cases who had complete tumor resection, and the only patient who progressed was the patient in whom the tumor was unresectable. Tumor cells in all cases exhibited positive staining for PDGFR and were negative for CD117 and HER2/neu. The expression of EGFR and VEGF was observed in 2 and 4 cases, respectively. CONCLUSION ESS arising from endometriosis is rare. Complete tumor resection in ESS arising from endometriosis may reduce the recurrence rate.
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Affiliation(s)
- Chunyan Lan
- State Key Laboratory of Oncology in South China, Guangzhou, PR China
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15
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Alcázar JL, Guerriero S, Ajossa S, Parodo G, Piras B, Peiretti M, Jurado M, Idoate MÁ. Extragenital endometrial stromal sarcoma arising in endometriosis. Gynecol Obstet Invest 2012; 73:265-71. [PMID: 22538201 DOI: 10.1159/000336522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 01/12/2012] [Indexed: 11/19/2022]
Abstract
The diagnosis rate of deep pelvic endometriosis is increasing. Endometrial stromal sarcoma (ESS) is a rare neoplasm. Extragenital ESS is an extremely uncommon event. Very few cases of extragenital ESS have been reported to date. The diagnosis of this entity is very difficult in some instances. Knowledge about its management is also limited. In this paper, we review the current literature on the clinical management, histology, immunohistochemistry, treatment and outcome of ESS arising in pelvic endometriosis.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
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16
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Mitchard JR, Lott M, Afifi RA, Hirschowitz L. Low-grade endometrial stromal sarcoma with glandular differentiation arising in ovarian endometriosis. J OBSTET GYNAECOL 2009; 24:596-7. [PMID: 15369960 DOI: 10.1080/01443610410001722879] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J R Mitchard
- Department of Cellular Pathology, Royal United Hospital, Combe Park, Bath, UK
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17
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Primary Extrauterine Endometrial Stromal Cell Sarcoma: A Case and Review. J Gastrointest Cancer 2009; 39:104-6. [DOI: 10.1007/s12029-009-9064-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 03/18/2009] [Indexed: 11/27/2022]
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18
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Kim L, Choi SJ, Park IS, Han JY, Kim JM, Chu YC, Kim KR. Endometrial stromal sarcoma of the small bowel: a case report and review of literature. Ann Diagn Pathol 2008; 12:128-33. [DOI: 10.1016/j.anndiagpath.2006.03.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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19
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Marchena-Gomez J, Conde-Martel A, Hemmersbach-Miller M, Alonso-Fernandez A. Metachronic malignant transformation of small bowel and rectal endometriosis in the same patient. World J Surg Oncol 2006; 4:93. [PMID: 17164003 PMCID: PMC1712233 DOI: 10.1186/1477-7819-4-93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 12/12/2006] [Indexed: 11/11/2022] Open
Abstract
Background Malignant transformation of intestinal endometriosis is a rare event with an unknown rate of incidence. Metachronous progression of endometriosis to adenocarcinoma from two distant intestinal foci happening in the same patient has not been previously reported. Case presentation We describe a case of metachronic transformation of ileal and rectal endometriosis into an adenocarcinoma occurring in a 45-year-old female without macroscopic pelvic involvement of her endometriosis. First, a right colectomy was performed due to intestinal obstruction by an ileal mass. Pathological examination revealed an ileal endometrioid adenocarcinoma and contiguous microscopic endometriotic foci. Twenty months later, a rectal mass was discovered. An endoscopic biopsy revealed an adenocarcinoma. En bloc anterior rectum resection, hysterectomy and bilateral salpingectomy were performed. A second endometrioid adenocarcinoma arising from a focus of endometriosis within the wall of the rectum was diagnosed. Conclusion Intestinal endometriosis should be considered a premalignant condition in premenopausal women.
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Affiliation(s)
- Joaquin Marchena-Gomez
- Department of General Surgery, University Hospital Gran Canaria "Dr. Negrin", Las Palmas G.C., Spain
| | - Alicia Conde-Martel
- Department of Internal Medicine, University Hospital Gran Canaria "Dr. Negrin", Las Palmas G.C., Spain
| | - Marion Hemmersbach-Miller
- Department of Internal Medicine, University Hospital Gran Canaria "Dr. Negrin", Las Palmas G.C., Spain
| | - Ana Alonso-Fernandez
- Department of Pathology, University Hospital Gran Canaria "Dr. Negrin", Las Palmas G.C., Spain
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Pishvaian AC, Ahlawat SK, Garvin D, Haddad NG. Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis. Gastrointest Endosc 2006; 63:331-5. [PMID: 16427951 DOI: 10.1016/j.gie.2005.06.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 06/09/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rectosigmoid endometriosis is an underrecognized cause of GI symptoms in women. Pelvic magnetic resonance imaging and CT have a low sensitivity in making this diagnosis. The role of EUS and EUS-guided FNA (EUS-FNA) in the diagnosis of rectosigmoid endometriosis in symptomatic patients is not well studied. METHODS A review of medical records identified 5 women who were diagnosed with rectosigmoid endometriosis by EUS and EUS-FNA over a period of 1 year. OBSERVATIONS Five women with nonspecific GI complaints underwent EUS examination of a rectosigmoid subepithelial mass found on colonoscopy. EUS revealed a hypoechoic lesion infiltrating the muscularis propria and the serosa of the rectal wall, and extending outside the rectal wall, findings consistent with rectosigmoid endometriosis. This diagnosis was confirmed by EUS-FNA, surgical exploration, and/or the patient's clinical course. CONCLUSIONS EUS and EUS-FNA are noninvasive, sensitive techniques for the diagnosis of rectosigmoid endometriosis in symptomatic patients.
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Affiliation(s)
- Aline Charabaty Pishvaian
- Division of Gastroenterology and Department of Pathology, Georgetown University Hospital, Washington DC, USA
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Raffaelli R, Piazzola E, Zanconato G, Fedele L. A rare case of extrauterine adenosarcoma arising in endometriosis of the rectovaginal septum. Fertil Steril 2004; 81:1142-4. [PMID: 15066480 DOI: 10.1016/j.fertnstert.2003.09.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2003] [Revised: 09/02/2003] [Accepted: 09/02/2003] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To present a rare case of endometrial stromal sarcoma arising in endometriosis of the rectovaginal septum. DESIGN Case report. SETTING Academic tertiary referral center for endometriosis treatment. PATIENT(S) A 50-year-old woman with a history of endometriosis presented with catamenial rectal pain and deep dyspareunia. Imaging findings suggested new endometriotic lesions in the rectovaginal space. INTERVENTION(S) Total hysterectomy, salpingo-oophorectomy, and excision of the lesion in the rectovaginal septum were performed. Although extemporary pathology confirmed endometriosis, the final histologic diagnosis was extrauterine adenosarcoma in the rectovaginal septum. Two years later, recurrence of the malignancy occurred and was treated by resecting the new perirectal mass. Subsequent radiotherapy and chemotherapy were administered. MAIN OUTCOME MEASURE(S) Imaging findings at follow-up evaluation. RESULT(S) The patient was in good health for 2 years after the initial surgery, when she developed a new lesion at the site of the previous resection. The histologic appearance of the lesion was consistent with recurrence of the tumor. After postoperative therapy, the patient is now without evidence of disease. CONCLUSION(S) Malignant transformation of endometriosis should be considered in the differential diagnosis of a new pelvic lesion in a patient with a history of endometriosis.
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Huang HY, Ladanyi M, Soslow RA. Molecular Detection of JAZF1-JJAZ1 Gene Fusion in Endometrial Stromal Neoplasms with Classic and Variant Histology. Am J Surg Pathol 2004; 28:224-32. [PMID: 15043312 DOI: 10.1097/00000478-200402000-00010] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Endometrial stromal tumors (ESTs), including low-grade endometrial stromal sarcomas (LGESSs) and endometrial stromal nodules (ESNs) of classic histology, exhibit characteristic morphologic features and contain the nonrandom t(7;17)(p15; q21), which results in the fusion of two novel genes, JAZF1 and JJAZ1. ESTs may pose diagnostic challenges when they involve extrauterine sites, present as metastases, or display variant histologic appearances. The aim of this study was to evaluate the frequency of the JAZF1-JJAZ1 gene fusion among primary uterine, metastatic, and primary extrauterine ESTs of various histologic types and its role as a possible diagnostic adjunct. Using a nonnested reverse transcriptase-polymerase chain reaction approach, we assayed for JAZF1-JJAZ1 gene fusion transcripts in 10 cases with available fresh-frozen tissue. These included five primary uterine (two classic, one mixed smooth muscle, and one epithelioid LGESS; one classic ESN), four metastatic (two fibromyxoid, one classic, and one epithelioid LGESS), and one extrauterine (classic LGESS) tumor. The same primer set and assay conditions were used on five additional paraffin-embedded cases with adequate RNA, including three primary uterine (one fibromyxoid and one mixed smooth muscle LGESS; 1 mixed smooth muscle ESN) and two intraabdominal recurrent (two mixed smooth muscle LGESSs) ESTs. Two cellular leiomyomas and one ESS cell line (ESS-1) without the t(7;17) at the cytogenetic level were run in parallel as controls. JAZF1-JJAZ1 gene fusion transcripts were detected in five (33%) of 15 ESTs, including three of eight primary uterine, one of four metastatic, one of one extrauterine, and none of two recurrent cases. Most ESTs of classic histology showed evidence of JAZF1-JJAZ1 fusion (4 of 5 cases), whereas only one mixed smooth muscle ESN of 10 variant cases was positive. Positivity for JAZF1-JJAZ1 fusion transcripts was found in four of 10 fresh-frozen samples and in one of five paraffin-embedded ESTs. The control specimens were all negative. In conclusion, our data suggest that ESTs are genetically heterogeneous, with the prevalence of the JAZF1-JJAZ1 fusion being highest among ESTs of classic histology. Hence, the diagnostic utility of a JAZF1-JJAZ1 fusion transcript assay in ESTs may be limited to the classic histologic subset.
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Affiliation(s)
- Hsuan-Ying Huang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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