Abstract
A low grade endometrial stromal sarcoma (LGESS) is characterized by slow progression and late recurrence; therefore, it is important to manage recurrent disease with surgery and progestin therapy. We report a case treated by laparoscopic surgery for pelvic disseminations of a LGESS. A 49-year-old woman underwent a vaginal hysterectomy for uterine fibroids seven years ago; it was pathologically diagnosed as a LGESS postoperatively. She refused both a re-operation, including bilateral salpingo-oophorectomy, and adjuvant hormone therapy. Almost seven years after the surgery, she underwent video-assisted thoracic surgery (VATS) on two occasion for excision of multiple pulmonary nodules; she also received high dose medroxyprogesterone acetate therapy (600 mg/day). Subsequently, new metastatic pulmonary nodules and pelvic cystic masses, which were suspicious for metastatic disease of the ovaries appeared. We strongly recommended surgery. At surgery, both ovaries had a normal appearance; however, there were several disseminated nodules near the vaginal stump. All these tumors did not deeply invade the intraperitoneal space; therefore, we could readily and completely remove them without any intra-operation adverse events. Postoperative histology revealed recurrence of a LGESS to the pelvis and both adnexa. Presently at approximately postoperative 12 months, no postoperative complication has been reported with the remaining lung nodule showing a decreasing tendency. We conclude that complete surgical excision has a potent effect on LGESS, even for recurrent tumors. Furthermore, laparoscopic surgery is recommended because it is a less invasive procedure with a lower risk of postoperative complications.
