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. 2022 May:94:107163.
doi: 10.1016/j.ijscr.2022.107163. Epub 2022 May 4.

A giant metastatic low-grade endometrial sarcoma requiring surgical management

Freddy Houéhanou Rodrigue Gnangnon  1 , Ismaïl Lawani  2 , Habib Ndome Natta N'tcha  3 , Edwin Kelly Haag  3 , Francis Moïse Dossou  2 , Delphin Kuassi Mehinto  3
Affiliations

A giant metastatic low-grade endometrial sarcoma requiring surgical management

Freddy Houéhanou Rodrigue Gnangnon et al. Int J Surg Case Rep. 2022 May.

Abstract

Introduction and importance: Low-grade endometrial stromal sarcomas are relatively rare tumors. We here report a case of a woman presenting with a giant metastatic low-grade endometrial stromal sarcoma with thromboembolic complications requiring urgent surgical management.

Case presentation: A 58-year-old obese female was admitted, with a voluminous abdominopelvic mass, due to complications related to its size and extent. The tumor derived from the uterus and invaded the ureters, bladder and rectum. It compressed the right iliac vessels causing both deep vein thrombosis and pulmonary embolism. She developed a painful irreducible umbilical. We proceeded with a debulking surgery (hysterectomy with bilateral salpingo-oophorectomy). Histological findings were consistent with a low-grade endometrial stromal sarcoma.

Clinical discussion: Low-grade endometrial stromal sarcomas are generally low-grade malignant neoplasms with an indolent clinical course. Surgery is the cornerstone of treatment. In low-income countries, malignancies are more often diagnosed at a late stage, which limits therapeutic options. Cytoreduction is recommended in advanced tumors with extrauterine manifestation, depending on symptoms and with palliative intent.

Conclusion: Low-grade endometrial stromal sarcomas are indolent uterine malignancies with metastatic potential. Even in advanced cases, cytoreduction must be considered.

Keywords: Case report; Cytoreduction surgery; Low-grade endometrial stromal sarcoma; Pulmonary embolism.

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Conflict of interest statement

All authors declare no conflicts of interest associated with this manuscript.

Figures

Fig. 1
Fig. 1
Computed tomography, transversal (a) and sagittal (b) sections showing a 32 × 28 × 18 cm abdominopelvic heterogenous mass (white arrow).
Fig. 2
Fig. 2
a. Surgical extraction of a voluminous uterine tumor; b. the resected specimen 32 × 25 × 13 cm.
Fig. 3
Fig. 3
Proliferation resembling a cytogenic chorion with discreet cellular atypia and low mitotic activity (black star), less than 5 per 10 high-powered fields; myometrium (white star) is infiltrated (a). Strong and diffuse staining of CD10 at immunohistochemistry (b).
See this image and copyright information in PMC

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