Single-Stage Resection of a Mixed Endometrial Stromal Sarcoma and Smooth Muscle Tumor With Intracardiac and Pulmonary Extension

Low-Grade Endometrial Stromal Sarcoma with Florid Intravenous Component

“…Despite its apparent tendency for lymphatic and venous extension, LGESS has seldom been observed with metastases to the larger vessels. A systematic literature search was performed using MEDLINE search engine and found only 17 reported cases from 14 publications in the English literature in the last 30 years ( table 1 ) [9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

A well circumscribed uterine endometrial stromal tumor with smooth muscle differentiation recurred as a low grade endometrial stromal sarcoma: Is tumor margin enough for the diagnosis?

“…An arbitrary cut‐off point of 30% is currently used for designating ‘mixed’ endometrial stromal and smooth muscle tumors; 1,4 however, the amount of either endometrial stromal or smooth muscle component does not seem to critically determine the clinical behavior of these mixed neoplasms, because recurrence and extensive invasion of the tumor have been observed in tumors composed predominantly of benign appearing smooth muscle components and a minor endometrial stromal tumor components 5 . Among the recurrent tumors, some recurred as a low grade endometrial stromal sarcoma as in our case, 1,6 and some as a mixed form 5,7 . Thus, the histologically distinct stromal and smooth muscle components in the tumor seem to have transdifferentiation along the tumor recurrences or metastases.…”

Cardiac metastatic endometrial stromal sarcoma 17 years after hysterectomy

“…ESS accounts for less than 1% of all uterine tumors . The ESS is staged as IA (< 5 cm), IB (5 cm), IIA tumor limited to pelvic cavity but extended beyond the uterus, IIB pelvic cavity invasion, III tumor outside the pelvic cavity, IVA cavity invading the bladder, and metastasis IVB .…”

“…Surgery is the most important procedure in the management of these patients. Single‐stage or two‐stage operation with or without hypothermic circulatory arrest have been used for resection of the ESS with IVC and cardiac extension …”

“…Metastatic tumors to the heart may occur simultaneously or years later following a successful resection of the primary tumor . Endometrial stromal sarcoma (ESS) are uncommon, especially when they present as an isolated cardiac mass . We report a patient who presented with a right ventricular (RV) mass consistent with an ESS 17 years following a hysterectomy and radiation therapy for the same tumor.…”