Stromal Endometriosis

Stromal Endometriosis is thought to be a primary uterine neoplasm arising from the stromal cell of the endometrium. It has been variously recorded as endometrial sarcoma, endometrial sarcoids, endolymphatic stromal myosis, stromal adenomyosis, proliferative stromatosis, perithelioma, fibromyosis, and endometrioma interstitiale (2–6). As far as can be determined, the first 2 cases were reported by Doran and Lockyer (1). Since then, about 100 cases have appeared in the English literature. Hunter et al. (4) stressed the fact that the histologic structure tends to be the same whether the growth takes the form of uterine polyps or myoma-like masses, stating, also, that the histologic appearance does not furnish a true measure of the eventual outcome. Stearns (6) states that while the disease is most often benign, it may be histologically malignant. It may invade normal tissue and metastasize to distant parts. The following case will serve to re-emphasize this entity. Case Report S. B. H., a 42-year-old woman, was first seen at the Hospital of the University of Pennsylvania in May 1944, complaining of burning, pain, and frequency of urination following a course of x-ray therapy to the pelvis. In 1942 she had first noted severe right lower abdominal pain occurring during menstruation. Large blood clots were passed vaginally, and there was slight abdominal enlargement. Pelvic examination was reported to have revealed a large mass associated with the uterus, thought to be a fibroid. A supracervical hysterectomy was performed at another institution. On gross examination the uterus measured 10 × 12 × 14 cm., its cavity being distorted by a fibroid and filled with an overgrowth of firm yellow endometrium with hemorrhage on the free margins. The histologic diagnosis was fibroma uteri with sarcomatous degeneration. The patient did well until May 1944, when she experienced a recurrence of symptoms. Pelvic examination revealed a large mass with involvement of the lateral pelvic wall. An intravenous urogram failed to visualize the left kidney. Since the lesion was thought to be malignant, it was decided to undertake a course of radiation therapy. The patient received a calculated dose of 3,450 rads (3,640 roentgens) to the midplane of the mass, through two anterior and two posterior portals, parallel and opposed, measuring 15 × 15 cm. each, with conventional voltage technic (200 kvp; 1.0 mm. Cu plus 1.0 mm. Al filtration; h.v.l. 1.0 mm. Cu), in thirty-seven elapsed days. Physical examination at the time of her first follow-up visit, one month following completion of x-ray therapy, showed a stony hard mass occupying the greater portion of the true pelvis, more marked on the left. Three months later the mass was smaller but still prominent. Interstitial implantation was then chosen as the modality of therapy. Eleven radium needles4 of 3 5 cm. active length, with 0.63 mg. of radium per centimeter, were implanted in the mass with uniform distribution.