Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5625-5631
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5625
Endometrial stromal sarcoma extending to the pulmonary artery: A rare case report
Jian-Kun Fan, Guang-Cai Tang, Han Yang
Jian-Kun Fan, Guang-Cai Tang, Han Yang, Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Author contributions: Fan JK collected the images, analyzed and interpreted the imaging findings, reviewed the literature and wrote the manuscript; Yang H collected clinical data and reviewed the literature; Tang GC designed the research, reviewed and revised the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Guang-Cai Tang, MD, Chief Doctor, Director, Full Professor, Department of Radiology, The Affiliated Hospital of Southwest Medical University, No. 23 Taiping Street, Luzhou 646000, Sichuan Province, China. 168345315@qq.com
Received: May 7, 2020
Peer-review started: May 7, 2020
First decision: September 14, 2020
Revised: September 21, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: November 26, 2020
Abstract
BACKGROUND

Endometrial stromal sarcoma (ESS) is a rare malignant mesenchymal tumor. Early in the disease, the findings on magnetic resonance imaging are similar to those of leiomyoma. When the lesion involves both vascular and cardiac tissue, it might be misdiagnosed as intravenous leiomyomatosis, which is not common in the clinic.

CASE SUMMARY

We present the case of a 34-year-old female patient with tumor embolus, which extended from the right iliac vein and ovarian vein to the inferior vena cava (IVC), and then to the right atrium and right ventricle, and finally protruded into the pulmonary artery. The patient had undergone a hystero-myomectomy 7 years previously. Based on the findings of the imaging examinations, the diagnosis of intravenous leiomyomatosis was considered preoperatively. The patient then underwent complete resection of the endovascular and intracardiac tumor embolus. The postoperative pathology results confirmed metastatic ESS with endovascular and intracardiac involvement. The patient was discharged from hospital in good condition, and there was no sign of recurrence 5 mo after the operation.

CONCLUSION

Extending from the iliac vein and ovarian vein to the IVC, this metastatic ESS invaded both vascular and cardiac tissues. For patients with ESS involving vascular and cardiac tissues, pathological examinations are essential for the differential diagnosis, such as intravenous leiomyomatosis. In addition, due to the high recurrence rate of ESS, long-term and close follow-up evaluation is necessary.

Keywords: Endometrial stromal sarcoma, Pulmonary artery, Inferior vena cava, Intracardiac extension, Endovascular extension, Case report

Core Tip: Endometrial stromal sarcoma (ESS) is a rare mesenchymal malignant tumor which is infrequently complicated by endovascular and intracardiac involvement. We report a case of ESS with diffuse myometrial infiltration, as well as endovascular and intracardiac involvement. From the iliac vein and ovarian vein to the inferior vena cava, the metastatic ESS in our patient invaded vascular and cardiac tissues.