A case of endometrial stromal sarcoma

A 42 years old P 2 +0 coming from a low socio-economic family and married for 22 years was admitted on 24 January, 2005 with complaints of menometrorrhagia of 5 years duration and mild intermittent lower abdominal pain of 4 months duration. Both her deliveries were normal. She was treated outside with hormones without much improvement. Her last menstruation was on 10 January, 2005. She had no hypertension, diabetes mellitus, and exposure to radiation. General examination and examination of the abdomen revealed nothing significant. Pelvic examination showed a 8 weeks size retroverted uterus with restricted mobility. Cervix and the fornices were normal. Baseline investigations were normal. Chest x-ray was normal. Ultrasonography done on 2 December, 2004 showed bulky uterus with a small fibroid. Both ovaries were enlarged with heterogeneous echotexture and right ovary had a small cyst with hemorrhage. Provisional diagnosis was endometriosis with uterine fibroid. Endometrial biopsy done on 26 December, 2004 showed proliferative endometrium. Laparotomy done under spinal anesthesia on 27 January, 2005 showed that the uterus was enlarged to 8 weeks size with intact surface. There was a yellowish rubbery mass of 3 x 2 cm in the right adnexa. Right ovary was not seen separately. There was another irregular