Abstract
Endometrial Stromal Sarcomas (ESSs) are very rare malignant tumors that constitute approximately 10% of all uterine sarcomas but only around 0.2% of all uterine malignancies (1) The annual incidence of ESS is 12 per million women. It is also known as endometrial stromal myosis. The median age was 44.35 6 years. Women with ESS are younger than women with other uterine sarcomas, with a median age between 45 and 57 years and, generally do not have the usual risk factors for endometrial cancer. Reported cases of endometrial stromal sarcoma in a postmenopausal woman are a rare entity. These tumors are said to be hormone dependent and therefore seems to be more common in reproductive and perimenopausal age group. Patients mainly presents with complaints of heavy vaginal bleeding and pain abdomen. ESS can be mistaken for leiomyoma. Clinical and radiology findings are suggestive of a leiomyoma. HPE remains the mainstay for diagnosis of such tumors. As these tumors are known for their recurrences close follow up of these patients is very important.
Highlights
These tumors are said to be hormone dependent and seems to be more common in reproductive and perimenopausal age group
Study reveals a specific translocation t{7;17} {p15;q21} with involvement of two zinc fingers genes juxtaposed with another zinc protein 1.2 CD 10 is expressed in Endometrial Stromal Sarcomas (ESSs) along with inhibin which helps it to differentiate with cellular leiomyoma that does not express CD 10.3 Estrogen and Progesterone receptors are found to be positive in ESS which further helps in evaluating the prognosis of tumor and thereby there rare occurrence in postmenopausal age group
undifferentiated endometrial sarcomas (UES) represents a high-grade sarcoma that lacks specific differentiation and bears no histological resemblance to endometrial stroma and the term ESS is considered best restricted to neoplasm that are formally referred to as low-grade ESS
Summary
A postmenopausal, 70 year old woman (P3) visited our O.P.D with complaints of heavy bleeding per vaginum since three months, which was not associated with any pelvic or abdominal pain. 1.1 Per vaginum examination OS admitted one finger; a smooth large polyp like structure felt arising from lateral wall of uterus filling the endometrial cavity and uterus was regularly enlarged to 12 weeks with b/l adnexa free. Her routine investigations (Hb, total leucocyte counts, total platelet counts, coagulation profile, renal function and liver function tests) were within normal limts. Cut section of the specimen revealed a smooth solitary ovoid mass in the endometrial cavity measuring appx 7x5 cms in dimensions and was free from all sides from myometrium except on the left where it was attached through its broad base. Patient had uneventful recovery & was discharged on D6 postoperatively with advice to remain in follow up and consult medical oncologist for further treatment
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