Endometrial stromal sarcoma metastatic to the lung: a detailed analysis of 16 patients

Marie-Christine Aubry, Aubry MC, Myers JL, Jeffrey L. Myers, Thomas V. Colby, Colby TV, Leslie KO, Kevin O Leslie, Tazelaar HD, Henry D Tazelaar
The American journal of surgical pathology · 2002 · doi:10.1097/00000478-200204000-00005 · PMID:11914621
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This analysis of 16 patients with lung metastases from endometrial stromal sarcoma describes clinical features, histological characteristics, and immunoprofiles to aid in distinguishing these tumors from other neoplasms such as endometriosis.

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This study analyzed lung specimens from 16 patients with endometrial stromal sarcoma metastatic to the lung, noting that uterine primary tumors were diagnosed an average of 9.8 years prior in most cases. The research highlights that these metastases often present as multiple nodules and can mimic other conditions such as endometriosis, sclerosing hemangioma, or carcinoid tumor during diagnostic evaluation. Pathological examination revealed characteristic features including plump spindle cells and strong expression of estrogen and progesterone receptors, which aid in distinguishing this rare malignancy from benign mimics. Relevance to endometriosis: endometriosis is listed as a differential diagnostic consideration for pulmonary nodules in women, though the paper's primary focus remains on the pathology of metastatic endometrial stromal sarcoma.

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Abstract

Pulmonary metastases of endometrial stromal sarcoma (ESS) are uncommon and can pose diagnostic problems. We reviewed lung specimens from 16 patients with metastatic ESS. Patients were 31-77 years of age at the time of lung biopsy. Uterine ESSs were diagnosed an average of 9.8 years before lung biopsy in 11 patients. Uterine ESSs were originally called smooth muscle tumors in three additional patients. Thirteen patients were evaluated for new pulmonary nodules, seven of whom were asymptomatic. Nodules were multiple in 14 and solitary in four, ranging from 1.0 to 8.0 cm in greatest dimension. One patient died of metastatic disease; 14 were alive and seven of these were without disease (mean follow-up 4.1 years). Diagnostic considerations in 12 consultation cases included ESS, sclerosing hemangioma, carcinoid tumor, lymphangioleiomyomatosis, endometriosis, hemangiopericytoma, and lymphoma. Tumors were well circumscribed and usually solid, composed of plump spindle cells arranged in short fascicles. Two tumors were predominantly cystic. Sex cord-like stromal differentiation was identified in three. Neoplastic cells stained for vimentin (93%), estrogen and progesterone receptor (100%), smooth muscle actin (57%), desmin (50%), and keratin (46%). Metastatic ESS should be included in the differential diagnosis of nonepithelial neoplasms in women.
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Endometrial Stromal Sarcoma Metastatic to the Lung A Detailed Analysis of 16 Patients - Marie-Christine Aubry - Jeffrey L. Myers - Thomas V. Colby - Kevin O. Leslie - Henry D. Tazelaar Pulmonary metastases of endometrial stromal sarcoma (ESS) are uncommon and can pose diagnostic problems. We reviewed lung specimens from 16 patients with metastatic ESS. Patients were 31–77 years of age at the time of lung biopsy. Uterine ESSs were diagnosed an average of 9.8 years before lung biopsy in 11 patients. Uterine ESSs were originally called smooth muscle tumors in three additional patients. Thirteen patients were evaluated for new pulmonary nodules, seven of whom were asymptomatic. Nodules were multiple in 14 and solitary in four, ranging from 1.0 to 8.0 cm in greatest dimension. One patient died of metastatic disease; 14 were alive and seven of these were without disease (mean follow-up 4.1 years). Diagnostic considerations in 12 consultation cases included ESS, sclerosing hemangioma, carcinoid tumor, lymphangioleiomyomatosis, endometriosis, hemangiopericytoma, and lymphoma. Tumors were well circumscribed and usually solid, composed of plump spindle cells arranged in short fascicles. Two tumors were predominantly cystic. Sex cord-like stromal differentiation was identified in three. Neoplastic cells stained for vimentin (93%), estrogen and progesterone receptor (100%), smooth muscle actin (57%), desmin (50%), and keratin (46%). Metastatic ESS should be included in the differential diagnosis of nonepithelial neoplasms in women.

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Condition tags

endometriosis

MeSH descriptors

Endometrial Neoplasms Lung Neoplasms Sarcoma, Endometrial Stromal Sarcoma, Endometrial Stromal Actins Actins Adult Aged Desmin Desmin Endometrial Neoplasms Female Humans Immunohistochemistry Keratins Keratins Lung Neoplasms Lung Neoplasms Lung Neoplasms Middle Aged

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