Undifferentiated Endometrial Sarcoma: Therapeutic Challenges Despite Good Surgical Resection

Abstract

Undifferentiated endometrial sarcoma is a rare uterine malignancy of mesodermal origin. Only a few cases have been reported in literature. Herein, we describe a 56-year old woman who presented with post-menopausal bleeding of a short duration. Endometrial curettings were suggestive of undifferentiated sarcoma. Computed tomography showed an enlarged uterus with welldened mass in the endometrial cavity extending down to the cervix. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy and omental biopsies were taken. Histological examination revealed a tumour with a permeative growth pattern composed of uniformly high grade round tumour cells with high mitotic activity. However, there was no lymphovascular space invasion. Tumour cells were strongly positive for CD10 signifying high grade endometrial stromal sarcoma (HG-ESS). Post R0 resection, patient is now receiving adjuvant chemotherapy. However, it is seen that most patients have early recurrence following even R0 resection.