Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8384
Peer-review started: April 3, 2022
First decision: June 16, 2022
Revised: June 22, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 16, 2022
Low-grade endometrial stromal sarcoma (LGESS) classically exhibits a proliferative morphology. However, morphological variation of extrauterine tumors presents a diagnostic challenge.
We report the case of a 76-year-old female patient with extensive extrauterine and abdominal neoplastic lesions. Computed tomography showed massive pleural and ascitic fluid, and there was an increase in serum cancer antigen 125. She underwent bilateral adnexectomy and tumor resection. The right ovary had been replaced by a multinodular mass that was 8.5 cm × 4.5 cm × 3.5 cm in size. In addition, there was a 24 cm × 15 cm × 13 cm mesenteric mass, which was also multinodular, with local invasion of the intestinal serosa and underlying muscle. Under the microscope, the tumors in different places exhibited two different patterns, thus presenting great challenges to diagnosis and treatment. Thorough pathological assessment eliminated all differential diagnoses in favor of metastatic LGESS derived from a 20-year-old primary tumor initially misdiagnosed as leiomyosarcoma.
LGESS morphology varies according to tumor location. Accurate diagnosis is critical for appropriate treatment and improved prognosis and patient care.
Core Tip: Low-grade endometrial stromal sarcoma (LGESS) could have a morphological variation of extrauterine tumors. These variations include smooth muscle differentiation, fibroma-like stromal pattern, and glandular differentiation. Misdiagnosis is common and may impact patient outcomes because of differences in the treatment approach for LGESS compared to that of other tumor types. Greater knowledge of LGESS morphological variability is critical in establishing a clear diagnosis and guiding patient care.