Cancer Res Treat.  2008 Mar;40(1):6-10.

Endometrial Stromal Sarcomas: A Retrospective Analysis of 28 Patients, Single Center Experience for 20 Years

• Nam EJ
• Kim JW
• Lee DW
• Jang SY
• Hong JW
• Kim YT
• Kim JH
• Kim S
• Kim SW

Abstract

PURPOSE: The aim of this study was to evaluate the behavior of endometrial stromal sarcomas (ESSs) in relation to their clinical and pathogenic features, and to determine the optimal treatment strategy.
MATERIALS AND METHODS
A retrospective analysis was performed involving 28 patients with histologic-proven ESSs treated at our institution between 1987 and 2006.
RESULTS
The median follow-up was 54.7+/-63.1 months and the 5-year survival rate was 82.0%. Twenty-two (81.5%) and 5 patients (18.5%) had low- and high-grade disease, respectively. Univariate analysis revealed that the histologic grades, based on mitotic count, were associated with longer survival (p=0.004). However, among those patients with low-grade tumors, 5/20 patients (25%) had a recurrence and 2/21 patients (9.5%) had distant metastasis during the follow-up period. With the exception of 2 patients, 26 patients with ESSs underwent hysterectomy as primary treatment. Adjuvant treatment after surgery was administered to 14/26 patients (53.8%). Hormone therapy with progesterone, chemotherapy, and/or radiotherapy did not influence overall survival. However, the postoperative adjuvant therapy group, regardless of the treatment modality, was associated with relatively increased overall survival when compared to the surgery only group (p=0.054).
CONCLUSION
The preoperative differential diagnosis of ESSs from other benign gynecologic diseases is often difficult. We recommend adjuvant therapy be administered after hysterectomy in patients with ESS to prevent recurrence or distant metastasis.

Keyword

Endometrial; Stromal; Sarcoma; Radiotherapy; Chemotherapy; Treatment outcome

MeSH Terms

Diagnosis, Differential
Female
Follow-Up Studies
Genital Diseases, Female
Humans
Hysterectomy
Neoplasm Metastasis
Progesterone
Recurrence
Retrospective Studies
Sarcoma
Sarcoma, Endometrial Stromal
Survival Rate
Treatment Outcome
Progesterone

Figure

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  Fig. 1 Low-grade ESS. The tumor resembles normal stroma of proliferative endometrium, characterized by generally uniform cells with minimal nuclear pleomorphism and cytologic atypia, hyalinized connective tissue, and a rich, vascularized background (left, hematoxylin and eosin; right, corresponding part of the left slide stained positive for CD10).

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  Fig. 2 High-grade ESS. The tumor is composed of anaplastic spindle cells that have a high mitotic index and frequently encountered abnormal mitotic figures. (left, hematoxylin and eosin; right, corresponding part of the left slide stained negative for CD10).

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  Fig. 3 Overall survival as a function of ESS grade.

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  Fig. 4 Overall survival based on adjuvant therapy after surgical treatment.

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