Radiation-Induced Uterine Stromal Sarcoma: A Case Report and Review of the Literature

Abstract

The radio-induced stromal sarcoma (RISS) is a rare clinical entity, being the second most common type of uterine mesenchymal neoplasm after leiomyosarcoma. Its incidence increases as survival after radiotherapy improves, and it often poses a therapeutic challenge. We report the case of a 58-year-old patient, followed since 2014 for initially classified stage IIb squamous cell carcinoma of the uterine cervix, treated with external pelvic radiotherapy and brachytherapy. After 6 years of surveillance, the patient presented with persistent pelvic pain. Clinical examination and pelvic MRI revealed the presence of a tumoral process in the uterine cervix with suspicious thickening of the endometrium. Morphological and immunohistochemical pathological study of the lesion confirmed its tumoral nature, indicative of a high-grade stromal sarcoma. Radiotherapy can induce malignant tumors after a latent period of several years. Radio-induced gynecological sarcomas are most often associated with a poor prognosis, emphasizing the need for careful and close monitoring after pelvic irradiation.