Endometrial Stromal Sarcoma from Endometriosis

Abstract

A 33-year-old patient came to our clinic in July 2008 because of abdominal pain and severe dysmenorrhea for 6 months. She had delivered 1 infant vaginally and 1 cesarean section. A diagnosis of bilateral endometriotic cysts had been made at ultrasonography 1 month before she came to our clinic. Aspiration of the cysts under ultrasound guidance had been performed, and material was found suggestive of endometriosis. Doppler ultrasonography performed at our clinic demonstrated bilateral enlarged ovaries (right ovary, 7 ! 6 cm; and left ovary, 11 ! 6 cm) with increased vascularity and low resistance flow. Computerized tomography scans showed a heterogeneous hypodense 10-cm mass in the pouch of Douglas. There was loss of fat between the lesion and the adjoining sigmoid bowel loop. Routine blood investigations yielded results within normal limits. CA 125 was 303 IU/mL. Because of suspected bilateral endometriosis, laparoscopy was performed. Laparoscopy revealed an enlarged left ovary with a 6-cm endometriotic cyst. The uterus was normal in size. There were multiple vesicular masses in the pouch of Douglas that were fleshy and highly vascular. The pouch of Douglas was completely obliterated by the mass, and the right ovary was embedded in the mass (Fig. 1). The liver appeared normal. There were multiple vesicular deposits in the omentum and bowel loops. Because of suspected malignancy, multiple biopsy specimens were obtained from the mass and sent for histopathologic analysis, which confirmed the lesion to be a low-grade endometrial stromal sarcoma (ESS) associated with endometriosis. The patient subsequently underwent