Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8384-8391
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8384
Metastatic low-grade endometrial stromal sarcoma with variable morphologies in the ovaries and mesentery: A case report
Hai-Yun Yu, Yu-Lan Jin
Hai-Yun Yu, Yu-Lan Jin, Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100003, China
Author contributions: Jin YL provided writing ideas; Yu HY collected data and analyzed them; both authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors state that there are no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yu-Lan Jin, MD, Chief Doctor, Professor, Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, No. 17 Qihelou Street, Dongcheng District, Beijing 100003, China.
Received: April 3, 2022
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.

Keywords: Gastrointestinal stromal tumor, Low-grade endometrial stromal sarcoma, Mesentery, Ovary, Tumor, Case report

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.