A Case Report of Recurrent Endometrial Stromal Sarcoma to the Breast, Lung and Pelvis after 15 years of Subtotal Hysterectomy

Abstract

Objective:a. To compare the effectiveness of tamoxifin and megestrol acetate drug on metastasis and recurrence low grade endometrial stromal sarcoma (LGESS). b. To identify the interval between the first presentation of LGESS and the recurrence of (LGESS).Methods: This is a rare case report of A 45-year-old woman with (LG-ESS), patients' history was collected by the authors ourselves through a structured interview, data was obtained from the patient's file including radiological pictures, pathological reports and drug doses. using PubMed data base for discussion this case. This woman with a history of hysteracomy and bilateral salpingooopharectomy 15 year earlier was admitted to Al Basheer hospital in 2015, presented with left breast mass, biopsy revealed (LGESS). CT scan have shown multiple breast and lung nodules. Doctor prescribed tamoxifen tab 20 mg once daily. After three months of follow up, the size of the metastatic nodules was increased, new umbilical mass and left hemipelvic mass were discovered. Then, megestrol acetate oral suspension had been prescribed 160mg daily. After 6 months of follow up the patient shown good response to treatment; the size of metastatic lungs and breast nodules were decreased, Umbilical and left hemipelvic lesions were decrease, but new small focal liver lesion was seen.Results: patient LG-ESS progression with tamoxifen by increasing the size of all nodules, but good response with megestrol acetate by decreasing the size of nodules. The disease was metastatic after 15 years old from first presentation. Conclusion:Megestrol acetate was effective treatment rather than tamoxefin in metastatic case, so administration of megestrol acetate is recommended for metastasis and recurrence (LG-ESS). Highlights:a. Megestrol acetate was considered as effective hormonal therapy for LGSS recurrence, metastasis and non resectable by tumor size regression. b. Tamoxifen was showed ineffective evidence by tumor size progression.