A case of low-grade endometrial stromal sarcoma which was indistinguishable from uterine leiomyoma

Abstract

  Low-grade Endometrial stromal sarcoma is a rare tumor that constitutes less than 1% of malignant uterine tumors. Because low-grade endometrial stromal sarcoma is located in the myometrium, it can be easily confused with uterine leiomyoma or adenomyosis uteri, so its diagnosis is often based on the postoperative pathology report. We present a case where low-grade ESS was diagnosed after a total laparoscopic hysterectomy (TLH) performed in the presence of an undiagnosed endometrial stromal sarcoma. A 48-year- old woman (who had had 4 pregnancies, 4 births) with a chief complaint of hypermenorrhea was referred to our department. Pelvic ultrasound and MRI revealed a degenerative interstitial leiomyoma that measured 23×20mm. We performed TLH. Histopathologic examination revealed a cellular neoplasm composed of spindle cells with myometrial invasion and lymphatic invasion. The tumor cells were positive for CD10 and for smooth-muscle actin, which resulted in the diagnosis of low-grade endometrial stromal sarcoma. After obtaining the patient's consent we performed bilateral salpingo-oophorectomy 3 months after the TLH. Lack of gross dissemination and negative peritoneal cytology were confirmed at the second surgery. The follow-up at 3 months after the second surgery TLH has been favorable.