Tuberc Respir Dis.  2014 Mar;76(3):131-135.

Endometrial Stromal Sarcoma Presented as an Incidental Lung Mass with Multiple Pulmonary Nodules

• Kang DO
• Choi SI
• Oh JY
• Sim JK
• Choi JH
• Choo JY
• Hwang JW
• Lee SH
• Lee JH
• Lee KY
• Shin C
• Kim JH

Abstract

Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Pulmonary metastasis of low-grade ESS can occur years and decades after the treatment of the primary disease. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, which can potentially lead to a misdiagnosis. We present a case of a 42-year-old woman with low-grade ESS, that initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after an uterine myomectomy. A 6.9x5.8 cm-sized intrapelvic mass suspected of uterine origin was discovered while searching for potential extrathoracic primary origin. A pelviscopy and simultaneous thoracoscopic lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on the histopathologic examination with immunohistochemical stain, which was showed positive for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens.

Keyword

Sarcoma, Endometrial Stromal; Multiple Pulmonary Nodules; Neoplasm Metastasis

MeSH Terms

Adult
Biopsy
Diagnosis
Diagnostic Errors
Female
Humans
Leiomyoma
Lung*
Mesoderm
Multiple Pulmonary Nodules*
Neoplasm Metastasis
Progesterone
Sarcoma, Endometrial Stromal*
Uterine Myomectomy
Uterine Neoplasms
Progesterone

Figure

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  Figure 1 (A, B) Chest computed tomography revealed a 4.5-cm sized well demarcated right perihilar mass (arrowhead) with mild enhancement of soft tissue density. Various sized circumscribed multiple nodules (arrows) are observed in periphery of both lungs.

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  Figure 2 Pelvic magnetic resonance imaging scan showed a 6.9×5.8-cm sized mass with internal fibrovascular septum (arrow) in midpelvic cavity which was moderately enhanced in a T1 weighted image (A). T2 weighted image (B) showed high signal intensity of the mass which was slightly abutted to the uterine fundus (arrowhead) suggestive of uterine origin rather than adnexal origin.

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  Figure 3 In positron emission tomography-computed tomography scan, pelvic mass (A) showed minimal hypermetabolism with maximum standardized uptake value of 1.32. Right perihilar mass (B) showed no definite fluorodeoxyglucose uptake, with maximum a standardized uptake value of 1.02.

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  Figure 4 Histopathologic examinations showed innocuous looking small oval to spindle shaped cells with scanty cytoplasm (C, H&E, stain, ×400) and perivascular arrangement which were infiltrating the normal myometrium (A, H&E stain, ×40) and lung structure (B, H&E stain, ×40). In immunohistochemical stain, tumor cells of uterus were strongly positive to progesterone receptors (D, ×200) and CD10 (E, ×200). Lung mass also showed positive CD10 staining (F, ×200).

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