Korean J Gastroenterol.  2020 Dec;76(6):322-326. 10.4166/kjg.2020.114.

Low-grade Endometrial Stromal Sarcoma Presenting as a Sigmoid Mass

• Ahn SR
• Lee JH

• KMID: 2509709
• DOI: http://doi.org/10.4166/kjg.2020.114

Abstract

Low-grade endometrial stromal sarcoma (LG-ESS) is a very rare mesenchymal neoplasm of the uterus. LG-ESS can recur or metastasize to extrauterine sites, such as the pelvis, peritoneal cavity, and vagina, but rarely to the lung, liver, heart, bone, and colon. A 42-year-old female patient was transferred from an outside clinic for an evaluation of constipation. EUS revealed a 5 cm hypoechoic lesion with a regular margin, probably arising from the 4th layer (muscular propria) at the sigmoid colon level. CT revealed a 7-cm homogenous enhancing mass lesion at the pelvic cavity and multiple enlarged lymph nodes in the sigmoid mesocolon.The patient underwent an anterior resection, and the diagnosis based on the biopsy result was LG-ESS. After a multidisciplinary discussion, she underwent a bilateral salpingo-oophorectomy. Small nodules found in the endometrium were identified as LG-ESS by a biopsy. This paper reports a case of metastatic LG-ESS presenting as a solitary sigmoid tumor without intrauterine lesions through preoperative examinations and discusses the characteristics of this neoplasm with reference to the relevant literature.

Keyword

Sarcoma; endometrial stromal; Sarcoma; Neoplasm metastasis; Colon

Figure

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  Fig. 1 A 5cm hypoechoic mass lesion with regular margin probably arising from the 4th layer (muscular propria) at the sigmoid colon level was detected by endoscopic ultrasonography.

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  Fig. 2 A 7-cm homogenous enhancing mass lesion was detected at the pelvic cavity and multiple enlarged lymph nodes in the sigmoid mesocolon by computed tomography (yellow arrow). The origin of the mass was unclear as it was adjacent to the cervix.

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  Fig. 3 A 7×5-cm mass lesion at the sigmoid was revealed by operative findings.

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  Fig. 4 A sheet of monomorphic spindle cells with scant cytoplasm and round or ovoid nuclei with dispersed chromatin were observed in the pathological findings (H&E, ×40). Immunochemical staining for CD10 was strongly positive (CD10, ×40).

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