Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2019; 7(2): 221-227
Published online Jan 26, 2019. doi: 10.12998/wjcc.v7.i2.221
Metastatic low-grade endometrial stromal sarcoma with sex cord and smooth muscle differentiation: A case report
Qi Zhu, Yan-Qin Sun, Xiao-Qing Di, Bing Huang, Jian Huang
Qi Zhu, Yan-Qin Sun, Xiao-Qing Di, Bing Huang, Jian Huang, Center of Pathology Diagnosis and Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
Yan-Qin Sun, Xiao-Qing Di, Bing Huang, Jian Huang, Department of Pathology, Guangdong Medical University, Dongguan 523808, Guangdong Province, China
Author contributions: Huang J found this rare case; Zhu Q and Di XQ performed the gross and histological examination; Huang B collected and analyzed the photos; Sun YQ and Huang J wrote, reviewed, and revised the manuscript; Zhu Q and Sun YQ contributed equally to this work.
Informed consent statement: Consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Huang, MD, Professor, Center of Pathology Diagnosis and Research, Affiliated Hospital of Guangdong Medical University, No. 57, South Renmin Avenue, Xiashan District, Zhanjiang 524023, Guangdong Province, China. 18665763598@163.com
Telephone: +86-759-2386985
Received: October 12, 2018
Peer-review started: October 13, 2018
First decision: November 15, 2018
Revised: December 9, 2018
Accepted: December 12, 2018
Article in press: December 12, 2018
Published online: January 26, 2019
Processing time: 107 Days and 1.1 Hours
Abstract
BACKGROUND

Metastatic low-grade endometrial stromal sarcoma (LG-ESS) with sex cord-like and smooth muscle-like differentiation is rare. This article reports such a case with multiple recurrences and with extensive pelvic and abdominal metastasis.

CASE SUMMARY

A 47-year-old female patient was diagnosed with multiple cystic masses in the pelvic cavity by magnetic resonance imaging examination. Based on the postoperative pathological and immunohistochemical analyses of the surgical specimen, she was diagnosed with a metastatic low-grade endometrial stromal sarcoma with sex cord and smooth muscle differentiation.

CONCLUSION

LG-ESS is a low-grade malignant tumor with a high recurrence rate and metastasis probability. It is easily misdiagnosed initially. It is essential to distinguish LG-ESS with sex cord-like differentiation from uterine tumour resembling ovarian sex cord tumour.

Keywords: Endometrial stromal sarcoma; Sex cord-like; Smooth muscle-like; Pathological changes; Immunohistochemistry; Case report

Core tip: Endometrial stromal sarcomas are common tumours. Metastatic low-grade endometrial stromal sarcoma (LG-ESS) with sex cord and smooth muscle differentiation, however, is an extremely rare diagnosis. To date, only two cases have been reported in the literature. Histopathologic examination revealed a uterine leiomyoma within a pelvic mass. LG-ESS with sex cord-like differentiation should be distinguished from uterine tumor resembling ovarian sex cord tumor.