J Gynecol Oncol.  2009 Jun;20(2):122-125. 10.3802/jgo.2009.20.2.122.

A case of multiple metastatic low-grade endometrial stromal sarcoma arising from an ovarian endometriotic lesion

• Kim JY
• Hong SY
• Sung HJ
• Oh HK
• Koh SB

• KMID: 2245096
• DOI: http://doi.org/10.3802/jgo.2009.20.2.122

Abstract

The development of endometrial stromal sarcomas (ESSs) in foci of endometriosis is extremely rare, and few cases have been reported in the literature to date, particularly with regard to multiple extrauterine ESS. Here we report a case of endometrial stromal sarcoma with multiple metastasis that arose from an ovarian endometriotic lesion. The literature is also briefly reviewed.

Keyword

Endometrial stromal sarcomas; Endometriosis; Ovary

MeSH Terms

Endometriosis
Female
Neoplasm Metastasis
Ovary
Sarcoma, Endometrial Stromal

Figure

• 

  Fig. 1 Computed tomography showing a necrotic solid mass measuring 7 cm in diameter on the left adnexa (B), a huge para-aortic solid mass lesion, and left renal vein and inferior vena cava thrombosis, which is suggestive of nodal metastasis (A, C). (A, B) axial image, (C) coronal image.

• 

  Fig. 2 Gross findings of the left ovary. The cut surface shows a diffuse dark reddish hemorrhagic lesion containing a solid focal yellowish lesion.

• 

  Fig. 3 Microscopic findings of the left ovary. The sections of the left ovary exhibit perivascular whorling proliferation of plump and spindle cells with a scanty cytoplasm and indistinct cell borders (A, hematoxylin-eosin, ×200; B, hematoxylin-eosin, ×400). Immunohistochemical staining analyses revealed that the neoplastic cells were immunoreactive to CD10 (C, ×400) and ER (D, ×400).

Reference

1. Diesing D, Cordes T, Finas D, Loning M, Mayer K, Diedrich K, et al. Endometrial stromal sarcomas: a retrospective analysis of 11 patients. Anticancer Res. 2006. 26(1B):655–661.

2. Yokosuka K, Kumagai M, Aiba S. Low-grade endometrial stromal sarcoma recurring after 9 years. South Med J. 2002. 95:1196–1200.

3. Chang KL, Crabtree GS, Lim-Tan SK, Kempson RL, Hendrickson MR. Primary extrauterine endometrial stromal neoplasms: a clinicopathologic study of 20 cases and a review of the literature. Int J Gynecol Pathol. 1993. 12:282–296.

4. Baiocchi G, Kavanagh JJ, Wharton JT. Endometrioid stromal sarcomas arising from ovarian and extraovarian endometriosis: report of two cases and review of the literature. Gynecol Oncol. 1990. 36:147–151.

5. Mourra N, Tiret E, Parc Y, de Saint-Maur P, Parc R, Flejou JF. Endometrial stromal sarcoma of the rectosigmoid colon arising in extragonadal endometriosis and revealed by portal vein thrombosis. Arch Pathol Lab Med. 2001. 125:1088–1090.

6. Young RH, Prat J, Scully RE. Endometrioid stromal sarcomas of the ovary: a clinicopathologic analysis of 23 cases. Cancer. 1984. 53:1143–1155.

7. Hughesdon PE. The origin and development of benign stromatosis of the ovary. J Obstet Gynaecol Br Commonw. 1972. 79:348–359.

8. Hughesdon PE. The endometrial identity of benign stromatosis of the ovary and its relation to other forms of endometriosis. J Pathol. 1976. 119:201–209.

9. Mostoufizadeh M, Scully RE. Malignant tumors arising in endometriosis. Clin Obstet Gynecol. 1980. 23:951–963.

10. Zaloudek C, Hedrickson MR. Kurman RJ, editor. Mesenchymal tumors of the uterus. Blaustein's pathology of the female genital tract. 2002. New York: Springer;586–590.

11. Kim L, Choi SJ, Park IS, Han JY, Kim JM, Chu YC, et al. Endometrial stromal sarcoma of the small bowel. Ann Diagn Pathol. 2008. 12:128–133.

12. Leunen M, Breugelmans M, De Sutter P, Bourgain C, Amy JJ. Low-grade endometrial stromal sarcoma treated with the aromatase inhibitor letrozole. Gynecol Oncol. 2004. 95:769–771.

13. Paillocher N, Lortholary A, Abadie-Lacourtoisie S, Morand C, Verriele V, Catala L, et al. Low-grade endometrial stromal sarcoma: contribution of hormone therapy and etoposide. J Gynecol Obstet Biol Reprod (Paris). 2005. 34:41–46.

14. Burke C, Hickey K. Treatment of endometrial stromal sarcoma with a gonadotropin-releasing hormone analogue. Obstet Gynecol. 2004. 104(5 Pt 2):1182–1184.

15. Bodner K, Bodner-Adler B, Obermair A, Windbichler G, Petru E, Mayerhofer S, et al. Prognostic parameters in endometrial stromal sarcoma: a clinicopathologic study in 31 patients. Gynecol Oncol. 2001. 81:160–165.