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Endometrial stromal tumors — are they hormonally sensitive?
Published in A. R. Genazzani, Hormone Replacement Therapy and Cancer, 2020
P. E. Schwartz, M. C. Chu, W. Zheng, G. Mor
The largest clinical series of low-grade endometrial stromal sarcoma patients reported to date is a collaborative multi-institutional series, consisting of 52 cases managed by gynecologic oncologists6. Seventy-one per cent of the patients were less than 50 years old (range 10–79 years). Five (9.6%) had a history of prior estrogen therapy. Surgical staging resulted in the upstaging of nine clinical stage 1 patients (seven stage III, two stage IV). Surgical staging revealed that 34 patients (65.6%) were stage I, three (5.7%) stage II, 11 (21.1%) stage III and four (7.6%) stage IV.
Benign tumors and tumor-like conditions, including metaplasia
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
The term ‘endometrial stromal tumor with limited infiltration’ has been recommended for those endometrial stromal tumors with satellite nodules or irregularities of border extending up to 9 mm from the main border of the tumor, but lacking the typical permeative pattern or vascular invasion of endometrial stromal sarcoma.29,30 Clinical data are limited in view of the small number of cases reported under this category, but these cases seem to follow a benign course similar to ESN.29,30
Endometrial cancer
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Mahalakshmi Gurumurthy, Margaret Cruickshank
Traditionally, ERT has not been advocated in the first two years following surgery for endometrial cancer because of the concern of activating any residual disease. However it is advisable to avoid ERT in women with endometrial stromal sarcoma, which are highly oestrogen-dependent tumours. There is, however, no evidence to support this, and the benefits of ERT may outweigh any theoretical risks [C]. In women aged 45 years or less, treated for early-stage disease, ovarian preservation has no effect on cancer-specific survival (HR 0.58, 95% CI 0.14–2.44) or overall survival (HR 0.65, 95% CI 0.34–1.35).24
Does ovarian preservation have an effect on recurrence of early stage low-grade endometrial stromal sarcoma?
Published in Journal of Obstetrics and Gynaecology, 2021
Volkan Karataşlı, İlker Çakır, Behzat Can, Selçuk Erkılınç, Tuğba Karadeniz, Oğuzhan Kuru, Mehmet Gökçü, Muzaffer Sancı
Low-grade endometrial stromal sarcoma is a rare type of uterine sarcoma (Hosh et al. 2016). It is generally diagnosed at the early stage of the disease in premenopausal patients (Chang et al. 1990). The treatment for the disease is surgery (Amant et al. 2014). Hysterectomy is recommended in patients who do not wish to have children (Amant et al. 2014). The prognosis of patients during the early stages is generally excellent (Chang et al. 1990; Yoon et al. 2014). However, late recurrences can occur (Chang et al. 1990; Amant et al. 2014). Because the disease is detected at a younger age and patients have a favourable prognosis at the early stage, the ovaries can be preserved in these patients to prevent the adverse effects of surgical menopause (Nasioudis et al. 2019). The role of oophorectomy in patients with low-grade endometrial stromal sarcoma has been investigated in several studies (Li et al. 2005; Amant et al. 2007; Stewart et al. 2018). There are conflicting data on the effect of ovarian preservation on the recurrence of endometrial stromal sarcoma. Patients who undergo bilateral salpingo-oophorectomy (BSO) have better disease-free survival (DFS) (Yoon et al. 2014; Nasioudis et al. 2019), but BSO does not appear to affect time to recurrence or overall survival (OS) (Li et al. 2005).
Long-term follow-up outcome and reintervention analysis of ultrasound-guided high intensity focused ultrasound treatment for uterine fibroids
Published in International Journal of Hyperthermia, 2020
Waixing Li, Zhaoying Jiang, Xinliang Deng, Dabao Xu
After HIFU treatment, the treated fibroids do not disappear immediately and thus need to explain to patients clearly. It is different from surgery, no pathological results obtained after HIFU. Therefore, pre-HIFU MRI is mandatory for patients with uterine fibroids who want to have HIFU treatment. Although MRI has the best soft tissue resolution and plays a key role in the differential diagnosis of uterine fibroids and uterine sarcomas, it is difficult to confirm the diagnosis based only on MRI in some atypical cases. Hence, the follow-up protocol is another important measure to prevent missed diagnosis of sarcoma. In this study, a 34-year-old patient presented with increased menstrual volume, MRI showed the tumor with hyperintensity on T2WI and moderate enhancement on contrast enhanced MRI. The initial diagnosis of uterine fibroid was made and the patient underwent USgHIFU treatment. She returned to our department for routine follow-up at 3 months after HIFU, she complained of irregular vaginal bleeding and the ultrasound examination did not show shrinkage of the treated fibroid. We reviewed the pre-HIFU MRI again and had a multiple discipline team discussion, thus uterine sarcoma was suspected and we ordered a follow up pelvic MRI for her. The MRI showed regrowth of the treated fibroid tumor with the features of endometrial stromal sarcoma. The patient then had hysterectomy and the pathological diagnosis of endometrial stromal sarcoma was confirmed. This patient has been followed up for 5 years without recurrence of endometrial stromal sarcoma.
Prognostic factors for uterine adenosarcoma: a review
Published in Expert Review of Anticancer Therapy, 2018
Michael J. Nathenson, Anthony P. Conley
The incidence of lymph node metastasis in uterine adenosarcomas is rare, namely 0–6.5% [5]. Consequently, lymphadenectomy is not routinely performed [15]. In a recent SEER database analysis, 994 cases of uterine adenosarcoma were identified, whereby the incidence of lymph node metastasis was 2.9% [22]. On multivariate analysis, lymph node metastasis was an independent prognostic factor for cause-specific survival, HR 2.34 (95% CI 1.29 to 4.25) and overall survival HR 2.04 (95% CI 1.20 to 3.46). This study compared uterine leiomyosarcoma and uterine endometrial stromal sarcoma to uterine adenosarcoma. Specifically, uterine adenosarcoma was associated with a significant improvement in survival when compared to uterine leiomyosarcoma and uterine endometrial stromal sarcoma, when examining lymph node negative cases. However, for those patients with positive lymph node metastasis, the 2-year cause-specific survival was similar between uterine adenosarcoma, uterine leiomyosarcoma, and uterine endometrial stromal sarcomas, 49.2%, 33.6%, and 37.6% [22]. This study further suggested a correlation between lymph node metastasis and sarcomatous overgrowth or myometrial invasion [22]. Lymph node metastasis is clearly a significant prognostic factor for uterine adenosarcomas.