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Manjula C, Beluru VS, Raju BH, Simon N. Primary low-grade extrauterine endometrial stromal sarcoma with sex cord elements involving the omentum: A case report with review of literature. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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Asokan R, Joseph LD, Mohanendran A, Krishnamoorthy S. Isolated ureteral extrauterine endometrial stromal sarcoma: an unusual presentation. BMJ Case Rep 2021; 14:e245099. [PMID: 34544718 PMCID: PMC8454433 DOI: 10.1136/bcr-2021-245099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 12/31/2022] Open
Abstract
Extrauterine endometrial stromal sarcomas (EUESSs) are rare tumours occurring without primary uterine involvement. They are classified as primary or secondary, depending on uterine involvement by stromal sarcomas. A 56-year-old woman who earlier underwent bilateral modified radical mastectomy for adenocarcinoma and total abdominal hysterectomy for endometrial stromal sarcoma, followed by tamoxifen therapy, presented with left loin pain. On evaluation, she had a left renal calculus with hydroureteronephrosis. Before percutaneous nephrolithotripsy, ureteroscopy revealed a polypoidal mass that was diagnosed as EUESS. The mass arose primarily within the ureteral lumen, with periureteric tissue uninvolved. She underwent left radical nephroureterectomy with adjuvant hormonal treatment. This is probably the first case of EUESS arising de novo from within the ureteral lumen without endometriosis, to be reported in medical literature. Immunohistochemistry facilitates earlier diagnosis. Cytoreductive surgery is the definitive treatment and multidisciplinary approach helps in overall survival of the patient.
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Affiliation(s)
- Raghavendran Asokan
- Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Leena Dennis Joseph
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arthi Mohanendran
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sriram Krishnamoorthy
- Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
- Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Suzuki S, Kurokawa R, Tsuruga T, Mori-Uchino M, Nishida H, Kato T, Abe H, Ushiku T, Amemiya S, Katayama A, Abe O. CT, MRI, and FDG-PET imaging findings of low-grade extrauterine endometrial stromal sarcoma arising from the mesentery: A case report. Radiol Case Rep 2021; 16:2774-2779. [PMID: 34367393 PMCID: PMC8326572 DOI: 10.1016/j.radcr.2021.06.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/07/2022] Open
Abstract
Endometrial stromal sarcoma is a rare uterine mesenchymal neoplasm, and extrauterine endometrial stromal sarcoma is even rarer, with a limited number of case reports. In the present report, we present a case of low-grade extrauterine endometrial stromal sarcoma originating from the mesentery in a 49-year-old woman, without endometrial stromal sarcoma in the uterus or evidence of endometriosis. The tumor was diagnosed using recombination of the JAZF1 gene by fluorescence in situ hybridization. Computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed a 13 cm, primarily polycystic, mass containing a contrast-enhancing solid component with restricted diffusion and mild 18F-fluorodeoxyglucose uptake. A large cystic component may be a characteristic feature of extrauterine endometrial stromal sarcoma, given the low pressure from the surrounding tissues.
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Affiliation(s)
- Satoshi Suzuki
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayuyo Mori-Uchino
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruka Nishida
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiori Amemiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akira Katayama
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Ahn SR, Lee JH. Low-grade Endometrial Stromal Sarcoma Presenting as a Sigmoid Mass. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 76:322-326. [PMID: 33361707 DOI: 10.4166/kjg.2020.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/07/2020] [Accepted: 10/10/2020] [Indexed: 11/03/2022]
Abstract
Low-grade endometrial stromal sarcoma (LG-ESS) is a very rare mesenchymal neoplasm of the uterus. LG-ESS can recur or metastasize to extrauterine sites, such as the pelvis, peritoneal cavity, and vagina, but rarely to the lung, liver, heart, bone, and colon. A 42-year-old female patient was transferred from an outside clinic for an evaluation of constipation. EUS revealed a 5 cm hypoechoic lesion with a regular margin, probably arising from the 4th layer (muscular propria) at the sigmoid colon level. CT revealed a 7-cm homogenous enhancing mass lesion at the pelvic cavity and multiple enlarged lymph nodes in the sigmoid mesocolon. The patient underwent an anterior resection, and the diagnosis based on the biopsy result was LG-ESS. After a multidisciplinary discussion, she underwent a bilateral salpingo-oophorectomy. Small nodules found in the endometrium were identified as LG-ESS by a biopsy. This paper reports a case of metastatic LG-ESS presenting as a solitary sigmoid tumor without intrauterine lesions through preoperative examinations and discusses the characteristics of this neoplasm with reference to the relevant literature.
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Affiliation(s)
- So Ra Ahn
- Department of Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Joo Hyun Lee
- Department of Surgery, Wonkwang University Hospital, Iksan, Korea
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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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Alan S, Yilmaz E, Tecellioglu F, Akatli AN, Inci Coskun E, Gokce H. Multifocal low-grade endometrial stromal sarcoma arising from pre-existing endometriosis in a hysterectomised patient: a case report. J OBSTET GYNAECOL 2019; 39:1177-1180. [PMID: 31195864 DOI: 10.1080/01443615.2019.1587599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Saadet Alan
- Department of Pathology, Inonu University School of Medicine, Turgut Ozal Medical Center , Malatya , Turkey
| | - Ercan Yilmaz
- Department of Gynecology and Obstetrics, Inonu University School of Medicine, Turgut Ozal Medical Center , Malatya , Turkey
| | - Fahriye Tecellioglu
- Department of Pathology, Inonu University School of Medicine, Turgut Ozal Medical Center , Malatya , Turkey
| | - Ayse Nur Akatli
- Department of Pathology, Inonu University School of Medicine, Turgut Ozal Medical Center , Malatya , Turkey
| | - Ebru Inci Coskun
- Department of Gynecology and Obstetrics, Inonu University School of Medicine, Turgut Ozal Medical Center , Malatya , Turkey
| | - Hasan Gokce
- Department of Pathology, Inonu University School of Medicine, Turgut Ozal Medical Center , Malatya , Turkey
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Efared B, Sidibé IS, Erregad F, Hammas N, Chbani L, El Fatemi H. Extra-uterine low grade endometrioid stromal sarcoma arising from ovarian endometriosis: a case report and review of the literature. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2019; 6:2. [PMID: 30723546 PMCID: PMC6350347 DOI: 10.1186/s40661-019-0067-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/16/2019] [Indexed: 11/16/2022]
Abstract
Background Endometrial stromal sarcoma (ESS) is a rare neoplasm accounting for only 0.2% of female genital tract tumors. The primary extra-uterine location of ESS is an extremely uncommon occurrence. Case presentation We present a case of a 64-year-old woman presenting with abdominopelvic and bilateral ovarian tumors with misleading clinical presentation and diagnostic challenge. The histopathological examination of the resected specimens disclosed the diagnosis of primary extra-uterine ESS arising from ovarian endometriosis. Adjuvant therapy with an aromatase inhibitor drug was prescribed for the patient, and she is still alive with no evidence of disease 7 months after surgery. Conclusion The awareness of the potential extra-uterine location of ESS should lead to correct diagnosis as this tumor has histopathological features and clinical behavior similar to its uterine counterpart.
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Affiliation(s)
- Boubacar Efared
- 1Department of pathology, Hassan II University Hospital, Fès, Morocco.,Department of pathology, FSS, UAM, Niamey, Niger
| | - Ibrahim S Sidibé
- 1Department of pathology, Hassan II University Hospital, Fès, Morocco
| | | | - Nawal Hammas
- 1Department of pathology, Hassan II University Hospital, Fès, Morocco.,3Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Laila Chbani
- 1Department of pathology, Hassan II University Hospital, Fès, Morocco.,3Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
| | - Hinde El Fatemi
- 1Department of pathology, Hassan II University Hospital, Fès, Morocco.,3Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, Fès, Morocco
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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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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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