Endometrial stromal sarcomas of the uterus with extensive endometrioid glandular differentiation: a report of three cases that caused problems in differential diagnosis.
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This report describes three cases of endometrial stromal sarcoma with prominent glandular differentiation that presented diagnostic challenges, requiring differentiation from other uterine and extrauterine müllerian lesions.
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Abstract
Three cases of endometrial stromal sarcoma (ESS) with prominent glandular differentiation within the primary or recurrent tumors are described. Each case posed a problem in diagnosis and classification. The patients, who ranged in age from 41 to 47 years, presented with abnormal uterine bleeding, a pelvic mass, or a combination thereof. All the patients underwent hysterectomy with or without bilateral salpingo-oophorectomy. There was no evidence of extrauterine spread of tumor in any case. Polypoid tumors involved the endometrium in two cases, and in one of them, tumor deeply invaded the myometrium. The tumor in the third case was an infiltrative mass that was confined to the myometrium and its vessels. On microscopic examination, the tumors were low-grade ESSs that contained large numbers of endometrioid glands, which were benign appearing in two cases, and in the third varied from atypical to carcinomatous. In one of the cases in the first group, the glandular component was present only in recurrent tumor excised 10 years after hysterectomy; prominent foci of sex-cord-like differentiation were also present in the recurrent tumor. This patient was clinically free of tumor 27 months later; follow-up in the other two patients was uneventful. ESSs with prominent numbers of benign-appearing glands should be distinguished from adenomyosis, endometriosis, ESSs arising in adenomyosis or endometriosis, ESSs with sex-cord-like differentiation, and müllerian adenosarcomas. ESSs with carcinomatous glands should be distinguished from endometrial adenocarcinomas and malignant müllerian mixed tumors (carcinosarcomas). Extrauterine lesions that have been designated "aggressive endometriosis" may be examples of extrauterine ESS with prominent glandular differentiation.
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Cited by (19)
- A Rare Case of Intestinal Low-Grade Endometrial Stromal Sarcoma With Glandular Differentiation and Associated Endometriosis 2021
- Arrangement of myofibroblastic and smooth muscle-like cells in superficial peritoneal endometriosis and a possible role of transforming growth factor beta 1 (TGFβ1) in myofibroblastic metaplasia 2018
- Pitfalls in the diagnosis of endometriosis: a condition characterized by a plethora of unusual histological features 2011
- Vascular Involvement in Adenomyosis: Report of a Large Series of a Common Phenomenon With Observations on the Pathogenesis of Adenomyosis 2010
- Endometrial stromal sarcomas with extensive endometrioid glandular differentiation: report of a series with emphasis on the potential for misdiagnosis and discussion of the differential diagnosis 2009
- Low grade endometrial stromal sarcoma with epithelial differentiation mimicking endometriosis 2009
- Mesenchymal uterine tumors, other than pure smooth muscle neoplasms, and adenomyosis 2009
- Ovarian Adenosarcoma With Extensive Deciduoid Morphology Arising in Endometriosis: A Case Report 2008
- Aggressive endometriosis with focal change suggesting early neoplastic transformation 2007
- Polypoid Endometriosis 2004
- Endometrial stromal sarcoma resembling adenomyosis and menstrual-phase endometrium 2004
- Multifocal polypoid endometriosis presenting as huge pelvic masses causing deep vein thrombosis. 2004
- Low-Grade Endometrial Stromal Sarcoma Arising From Sciatic Nerve Endometriosis 2004
- Extrauterine Low-Grade Endometrial Stromal Sarcoma With Florid Endometrioid Glandular Differentiation 2001
- Low-Grade Endometrial Stromal Sarcoma of the Ectocervix after Therapy for Breast Cancer 2000
- Uterine Adenomyomas Excluding Atypical Polypoid Adenomyomas and Adenomyomas of Endocervical Type: A Clinicopathologic Study of 30 Cases of an Underemphasized Lesion That May Cause Diagnostic Problems with Brief Consideration of Adenomyomas of Other Female Genital Tract Sites 2000
- Aggressive endometriosis: report of a case 2000
- Pathogenetic role of the stromal cells in endometriosis and adenomyosis 1998
- The pathology of hysterectomy specimens following trans‐cervical resection of the endometrium 1995
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