Cerebral Metastases of an Endometrial Stromal Sarcoma: Report of the First Case

Abstract

Background: Endometrial stromal sarcomas (ESSs) of the uterus are rare gynecological malignancies. Common locations of distant metastases are vagina, vulva, lung, mediastinum, abdomen, bones and ovaries. Case Report: We present the case of a 69-year-old woman with a Federation of Gynecology and Obstetrics (FIGO) IIb (classification 2009) ESS of the uterus of high-grade malignancy. Initially, a hysterectomy Piver II and total colpectomy were performed, followed by pelvic field irradiation. 8 months later, the patient suffered seizures and hemiparesis. A computed tomography (CT) scan revealed cerebral metastases, and irradiation of the brain was initiated. After completion of the staging examinations, additional metastases of lung, abdomen, mediastinum, vulva and inguinal lymph nodes were found. This is the first reported case of brain metastases of an ESS. Conclusion: Appropriate treatment options like surgery, chemotherapy or endocrine therapy should be discussed on an individual basis since large-scale clinical trials have not yet been conducted in this rare entity.

Brain Metastases from Adult Sarcomas: A Retrospective Cohort Study from the Hellenic Group of Sarcomas and Rare Cancers (HGSRC)

“…In our study, the most common histotypes were in agreement with the previous results. Furthermore, we also found some cases of rare sarcoma subtypes, including glomus tumor, endometrial stromal sarcoma and phyllodes tumor, for which there are case reports of brain metastases [28][29][30].…”

Hemorrhagic Brain Metastasis of Endometrial Stromal Sarcoma

“…Cranial metastasis of endometrial stromal sarcoma has been reported 4 times by different authors until now. One case had metastasis in the sphenoid bone and lumbar spine [14], another case had lung and cerebral metastasis [15], and the third case had multiple cerebral metastases [16]. The last case has been recently reported in 2013, and the patient in this case had a lesion mimicking meningioma and located at right occipital lobe [17].…”

Endometrial stromal sarcoma of the uterus presenting as pulmonary metastasis

“…The current case did not give any history related to her genital tract and she had been presented due to respiratory symptoms.Common locations of distant metastases are the vagina, vulva, lung, mediastinum, abdomen, bones and ovaries 9. There are small cases of unusual metastatic sites in patients with ESS such as the brain,10 heart,11 stomach12 and sigmoid colon 13. Butwhat distinguishes this case is the fact that pulmonary metastases was the initial presentation of ESS, the patient had a history of breast carcinoma andimmunoreactivity to CD10 was not found.…”

“…In addition, ESS is a genetically heterogeneous group of uterine sarcomas, of which almost half are associated with JAZF1 rearrangement. Lee et al 16 recently identified a novel genetic fusion between YWHAE and FAM22A/B in ESS harbouring t10 17 (q22;p13). They described the histological and IHC features for YWHAE-FAM22 ESS.…”