Disseminated Peritoneal Endometriosis Evolving to High-Grade Endometrial Stromal Sarcoma: A Case Report with Review of the Literature

Shruti Gupta, Parikshaa Gupta, Radhika Srinivasan, Subhash Chandra Saha, Seema Chopra, Pooja Sikka, Arvind Rajwanshi
In: Journal of Gynecologic Surgery · 2020 · vol. 36(4) , pp. 209–213 · doi:10.1089/gyn.2019.0144 · W3025442107
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This case report describes a 35-year-old female with disseminated peritoneal endometriosis who later developed high-grade endometrial stromal sarcoma in the gastro-splenic region.

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Abstract

Background: Endometrial stromal sarcomas (ESS) are uncommon mesenchymal neoplasms of the uterus, composed of cells closely resembling normal proliferative endometrial stromal tissue. ESS account for 0.2% of all uterine malignancies and 7%–15% of all uterine sarcomas. Endometriosis can undergo malignant transformation in ∼1% of women. ESS can develop many months to years after the original diagnosis, potentially creating a diagnostic challenge. Case: A 35-year-female presented with lower-abdominal pain for the last 3 months and secondary infertility. Ultrasonography of the abdomen and pelvis did not reveal any abnormality. Her serum cancer antigen–125 level was raised. A laparoscopic biopsy taken from her bowel adhesions revealed endometriosis. Two years later, the patient presented again with severe abdominal pain and massive ascites. Magnetic resonance imaging revealed peritoneal thickening with multiple nodular deposits in the pelvis and a cystic lesion in the right ovary. Based on a clinical suspicion of malignancy, total abdominal hysterectomy with bilateral salpingo-oophorectomy were performed. Histology testing of the samples revealed disseminated peritoneal endometriosis. One year later, she presented with pain in her abdomen and shortness of breath. Contrast-enhanced computerized tomography showed a mass in her pelvis and gastro-splenic region. Results: The subsequent histopathologic examination of the ruptured gastro-splenic mass revealed high-grade ESS. Conclusions: This case highlights the importance of closely following patients with endometriosis to ensure early diagnosis of malignant transformation. (J GYNECOL SURG 36:209)

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endometriosisinfertility

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