[Case Report] Characteristic of Endometrial stromal sarcoma by algorithm of potential biomarkers for uterine mesenchymal tumor

Abstract

BACKGROUND/AIM: The benign tumor uterine leiomyoma derives from the smooth muscle tissue that constitutes the uterus. In contrast, the malignant tumor uterine sarcoma can derive from either smooth muscle or stroma, and differs from both uterine leiomyoma and endometrial cancer. Uterine sarcoma is broadly classified into three types: uterine leiomyosarcoma, endometrial stromal sarcoma, and carcinosarcoma. However, although uterine leiomyosarcoma and endometrial stromal sarcoma are both classified as uterine sarcoma, they differ significantly in their sites of occurrence, symptoms, and treatment methods, among other factors. Uterine leiomyosarcoma arises from the muscle tissue constituting the wall of the uterus and accounts for approximately 70% of all uterine sarcoma cases. Endometrial stromal sarcoma arises from the stromal tissue beneath the endometrium and accounts for approximately 25% of all uterine sarcoma cases. Endometrial stromal sarcoma is classified as either low-grade or high-grade. MATERIALS AND METHODS: A patient’s symptoms suggested uterine sarcoma, transvaginal ultrasonography and endometrial biopsy or partial dilation and curettage were performed. However, in clinical practice, the sensitivity of those tests for detecting malignancy is limited, and endometrial stromal sarcoma and uterine leiomyosarcoma were diagnosed incidentally on histopathology examination of hysterectomy specimens or enucleated tumors. RESULT: Histopathology examination of a surgical specimen from a patient who was thought to have submucosal uterine leiomyoma after contrast-enhanced magnetic resonance imaging (MRI) found that the patient actually had endometrial stromal sarcoma. CONCLUSION: Despite the remarkable progress made in medical imaging technology, the accuracy of contrast-enhanced MRI for detecting uterine mesenchymal tumors is limited. Histopathologic diagnosis based on surgical specimens should therefore be performed when medical grounds for diagnosing a benign tumor on contrast-enhanced MRI are lacking.