From Diagnosis to Management: A Rare Case of Disseminated Low-Grade Endometrial Stromal Sarcoma with Extensive Extrauterine Spread

Adrian Djatikusumo, Yulian Prastisia, Iwan Kurnia Effendi, Wina Kanya Wasystha
In: Indonesian Journal of Obstetrics and Gynecology · 2025 · pp. 84–90 · doi:10.32771/inajog.v13i1.1893 · W4412978407
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This case report describes a 44-year-old woman with disseminated low-grade endometrial stromal sarcoma involving the uterus, ovaries, omentum, and jejuno-ileum who underwent surgical resection with no abnormalities detected at five-month follow-up.

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This case report describes a 44-year-old woman presenting with abdominal enlargement and pelvic pain who was diagnosed with disseminated low-grade endometrial stromal sarcoma involving the uterus, ovaries, omentum, and jejuno-ileum. Although the patient had no prior history of endometriosis, the authors highlight that risk factors and endometriosis history are critical to explore in such cases due to their potential association with disease development. Surgical resection and staging confirmed the diagnosis, and follow-up imaging five months post-operation showed no abnormalities. Relevance to endometriosis: The paper explicitly discusses the need for further research into the association between endometriosis and the development of endometrial stromal sarcoma, listing it as an important risk factor to explore despite this specific patient having no prior diagnosis.

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Abstract

Objective: To report a rare case of low-grade endometrial stromal sarcoma; which was found not only in the uterus but also in several extrauterine sites, such as the ovary, omentum, and jejuno-ileum. In this article, we provided the management performed, based on appropriate literatures. Methods: Case report. Case: A 44-year old para 2 complained of abdominal enlargement since 3 months. Patient also complained of pelvic pain. The patient has never received treatment before and has never been diagnosed with endometriosis. Abdominal examination revealed a 20-cm mass in the lower to umbilical region and positive shifting dullness. Bimanual pelvic examination revealed immobile and smooth masses in both sides of adnexa, with pain during palpation. Computerized tomography (CT) scan of the abdomen revealed complex cystic masses suspected for right and left ovaries-origin (±11 & 15 cm respectively) Surgical resection and staging, frozen section, cytology examination, and immunohistochemistry (IHC) test were performed, revealing consistent result of endometrioid stromal sarcoma, low grade. Five-months postoperative follow-up through abdominal CT-scan in the patient revealing no abnormalities. Conclusion: We know that LG-ESS is one of the rare types of endometrial stromal sarcoma. Moreover in this case extrauterine manifestations make it more challenging in clinical management. Risk factors and history of endometriosis are important to explore when meeting ESS cases. Further research needs to be done regarding the exact mechanism and the association between endometriosis or other risk factors and the development of ESS, especially the EESS type to allow intervention. Keywords: uterine sarcoma, endometrial stromal sarcoma, management.
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Objective

To report a rare case of low-grade endometrial stromal sarcoma; which was found not only in the uterus but also in several extrauterine sites, such as the ovary, omentum, and jejuno-ileum. In this article, we provided the management performed, based on appropriate literatures.

Methods

Case report. Case: A 44-year old para 2 complained of abdominal enlargement since 3 months. Patient also complained of pelvic pain. The patient has never received treatment before and has never been diagnosed with endometriosis. Abdominal examination revealed a 20-cm mass in the lower to umbilical region and positive shifting dullness. Bimanual pelvic examination revealed immobile and smooth masses in both sides of adnexa, with pain during palpation. Computerized tomography (CT) scan of the abdomen revealed complex cystic masses suspected for right and left ovaries-origin (±11 & 15 cm respectively) Surgical resection and staging, frozen section, cytology examination, and immunohistochemistry (IHC) test were performed, revealing consistent result of endometrioid stromal sarcoma, low grade. Five-months postoperative follow-up through abdominal CT-scan in the patient revealing no abnormalities.

Conclusion

We know that LG-ESS is one of the rare types of endometrial stromal sarcoma. Moreover in this case extrauterine manifestations make it more challenging in clinical management. Risk factors and history of endometriosis are important to explore when meeting ESS cases. Further research needs to be done regarding the exact mechanism and the association between endometriosis or other risk factors and the development of ESS, especially the EESS type to allow intervention.

Keywords

uterine sarcoma, endometrial stromal sarcoma, management.

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endometriosis

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