The Prognostic Significance of Surgery, Tumor Size, Malignancy Grade, Menopausal Status, and DNA Ploidy in Endometrial Stromal Sarcoma

Nordal, Randi R.; Kristensen, Gunnar B.; Kærn, J.; Stenwig, Anne Elisabeth; Pettersen, Erik O.; Tropé, Claes G.

doi:10.1006/gyno.1996.0224

Cited by 75 publications

(51 citation statements)

References 3 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similarly, Kokawa et al (2006) showed that younger age was an independent predictor of improved survival in multivariate analysis of 15 cases of ESS. In contrast, Nordal et al (1996) studied 48 patients with ESS and found that age was not significantly correlated to survival. In this study of over 800 patients, patients p52 years had more than a 20% higher 5-year DSS compared with older patients.…”

Section: Discussionmentioning

confidence: 95%

Endometrial stromal sarcoma: a population-based analysis

et al. 2008

View full text Add to dashboard Cite

To determine independent prognostic factors for the survival of patients with endometrial stromal sarcoma (ESS), data were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute from 1988 to 2003. Kaplan -Meier and Cox proportional hazards models were used for analyses. Of 831 women diagnosed with ESS, the median age was 52 years (range: 17 -96 years). In total, 59.9% had stage I, 5.1% stage II, 14.9% stage III, and 20.1% had stage IV disease. Overall, 13.0, 36.1, and 34.7% presented with grades 1, 2, and 3, respectively. Patients with stage I-II vs III-IV disease had 5 years DSS of 89.3% vs 50.3% (Po0.001) and those with grades 1, 2, and 3 cancers had survivals of 91.4, 95.4, and 42.1% (Po0.001). In multivariate analysis, older patients, black race, advanced stage, higher grade, lack of primary surgery, and nodal metastasis were independent prognostic factors for poorer survival. In younger women (o50 years) with stage I -II disease, ovarian-sparing procedures did not adversely impact survival (91.9 vs 96.2%; P ¼ 0.1). Age, race, primary surgery, stage, and grade are important prognostic factors for ESS. Excellent survival in patients with grade 1 and 2 disease of all stages supports the concept that these tumors are significantly different from grade 3 tumors. Ovarian-sparing surgeries may be considered in younger patients with early-stage disease.

show abstract

Section: Discussionmentioning

confidence: 95%

Endometrial stromal sarcoma: a population-based analysis

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Endometrial stromal sarcomas (ESSs) account for 0.2 to 1.5% of all uterine malignancies (1) and Ͻ10% of cases of uterine sarcomas (2). ESS is usually composed of uniform cells intimately associated with prominent arterioles, closely recapitulating proliferative endometrial stroma.…”

mentioning

confidence: 99%

Utility of CD10 in Distinguishing between Endometrial Stromal Sarcoma and Uterine Smooth Muscle Tumors: An Immunohistochemical Comparison of 34 Cases

et al. 2001

View full text Add to dashboard Cite

Endometrial stromal sarcoma (ESS), uterine cellular leiomyoma (UCL), and uterine leiomyosarcoma (ULS) are composed mainly of spindle cells that express similar antigens such as desmin, smooth muscle actin (SMA), and muscle-specific actin (MSA). The differential diagnosis of an ESS versus a uterine smooth muscle tumor or an extrauterine spindle cell sarcoma can be problematic based solely on clinical presentation, histologic assessment, or routine immunohistochemistry. Recently, we reported that normal endometrium, but not myometrium, as well as five cases of ESS, were positive for CD10. We now report the results of CD10 immunohistochemistry in an additional 11 cases of ESS (total 16 cases), 10 cases of UCL, and nine cases of ULS. CD10 immunoreactivity was detected in 16 of 16 cases of ESS (100%) as compared to only 2 of 10 cases of UCL (20%) and none of nine cases of ULS (0%). We compared the utility of CD10 immunoreactivity with that of desmin, SMA, MSA, estrogen receptor (ER), and inhibin in these tumors. Although the majority of cases of UCL and ULS were positive for SMA, MSA, and desmin, a substantial portion of cases of ESS were also positive for SMA, MSA, and desmin. We conclude that in combination with SMA, MSA, and desmin, CD10 is a useful immunohistochemical marker in the differential diagnosis of ESS versus UCL or ULS.

show abstract

“…Low grade tumors with a low mitotic rate and lacking atypia and pleomorphism behave in a more benign manner than the high grade neoplasms. 7,8,10 The role of hormonal therapy is well documented in these low grade tumors. 1,2,5,7,8 Steroid receptor detection by immunohistochemistry is valuable.…”

Section: Discussionmentioning

confidence: 99%

“…7,8,10 The role of hormonal therapy is well documented in these low grade tumors. 1,2,5,7,8 Steroid receptor detection by immunohistochemistry is valuable. It was also noted that tumors that expressed both estrogen and progesteronereceptors have benefited from progesterone therapy; especially low grade tumors.…”

Section: Discussionmentioning

confidence: 99%

Multi-Focal Extra-Uterine Endometrial Stromal Sarcoma (ESS): A Very Rare Complication of Endometriosis Associated with Elevated Serum CA-125

et al. 2003

View full text Add to dashboard Cite

Endometrial stromal sarcomas (ESS) in the female genital tract are uncommon and are usually of uterine origin.1,2,3 Extra-uterine ESS are extremely rare. Only 86 cases have been reported in the literature. 2,4 More than 50% of the cases were associated with pre-existing endometriosis. We report a case ofextrauterine low grade ESS associated with extensive endometriosis of the pelvis. We suspected that the tumor was a primary ovarian carcinoma due to elevated serum CA-125. Case ReportThe patient was a 45-year old premenopausal, multi-parous female (8 + 2). The patient presented with lower abdominal pain of 6 months duration associated with nausea and constipation.Her medical history included myomectomy for leiomyomas 17 years prior to this presentation. The patient was diabetic and hypertensive. Physical examination revealed a mass in the abdominal-pelvic region measuring 15 x 12 centimeters. Serum CA-125 was three times the normal range (197 mmol/L). Abdominal pelvic ultrasonography revealed an abdomino-pelvic mass of mixed echogenecity measuring 13x13 centimeters and located on the right side of the pelvis. The uterus was normal in size. A CT scan of the abdomen and pelvis showed a large heterogenouspelvi-abdominal mass with the epicenter in the region of the pelvic wall (Figure 1). The mass appeared adherent to the uterus and bowel wall. Laparotomy was performed and a mass adherent to the fundus of the uterus, the pelvic cul-de-sac and the bowel was found. There were multiple variable-sized nodules found in the wall of the pelvis, fallopian tubes and pelvic peritoneum. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with debulking was performed. The patient was given progesterone therapy (Megace R ) and was discharged. Grossly the tumor was composed of multiple yellow-tan fleshy nodules with focal cystic areas. Focal areas of hemorrhage and necrosis were identified. The tumor was near the right adnexa. The uterus, fallopian tubes andovaries showed multiple tumor nodules. Microscopically, the tumor consisted of diffuse sheets of small closely packed cells with uniform round oval nuclei with coarse, evenly dispersed chromatin and small inconspicuous nucleoli. The cytoplasm was scanty and its boundaries were not well defined. A distinct vascular pattern was identified (Figure 2). This pattern was more prominent on the reticulin stain (Figure 3). Mitotic figures were less than 1 in 10 /high power field. No cellular atypia or pleomorphism were identified. The tumor was strongly positive for estrogen and progesterone receptors (Figure 4). Multiple deposits of the tumor were identified in the omentum. The ovaries and tubes showed multiple foci of tumor and endometriosis ( Figure 5). The endometrium showed cystic hyperplasia without evidence of ESS.

show abstract

The Prognostic Significance of Surgery, Tumor Size, Malignancy Grade, Menopausal Status, and DNA Ploidy in Endometrial Stromal Sarcoma

Cited by 75 publications

References 3 publications

Endometrial stromal sarcoma: a population-based analysis

Endometrial stromal sarcoma: a population-based analysis

Utility of CD10 in Distinguishing between Endometrial Stromal Sarcoma and Uterine Smooth Muscle Tumors: An Immunohistochemical Comparison of 34 Cases

Multi-Focal Extra-Uterine Endometrial Stromal Sarcoma (ESS): A Very Rare Complication of Endometriosis Associated with Elevated Serum CA-125

Contact Info

Product

Resources

About