Extra-uterine endometrial stromal sarcoma arising from deep infiltrating endometriosis
We present a compelling case of a 45-year-old female with a history of endometriosis and leiomyomas, who presented to her gynecologist with chronic pelvic pain complaints. Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine l...
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| Veröffentlicht in: | Clinical imaging 2020-11, Vol.67, p.250-254 |
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| creator | Lipsich, Federico Causa Andrieu, Pamela I. Wernicke, Alejandra Patrono, María Guadalupe Napoli, Maria Noelia Chacon, Carolina Rosa Beatriz Nicola, Refky |
| description | We present a compelling case of a 45-year-old female with a history of endometriosis and leiomyomas, who presented to her gynecologist with chronic pelvic pain complaints.
Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine lesions, likely fibroids, and an endometrioma within the right ovary. The MRI of the pelvis with and without gadolinium identified a mass within the right ovary with homogenous intermediate T2-signal, restricted diffusion, and delayed enhancement relative to the myometrium. Several irregular-shaped lesions were also noted within the external myometrium, anterior pelvic wall, and the peritoneum, which were intermediate signal on T2-weighted images, restricted diffusion, and an enhancement pattern similar to the myometrium.
The patient underwent a right adnexectomy. The histopathology findings were consistent with a low-grade endometrial stromal sarcoma (low grade-ESS) arising from the endometrial stroma of the right ovary. A debulking surgery confirmed the involvement of external myometrium, anterior pelvic wall, and the peritoneum secondary to a low-grade ESS without the endometrial cavity's involvement.
The underlying hypothesis is that the endometriosis stroma from extra-uterine structures such as the right ovary, pelvic and anterior peritoneum, and external myometrium may have subsequently resulted in a low-grade ESS.
Low-grade extra-uterine ESS without endometrial involvement is a rare entity. Based on our literature search, this is one of the few reports covering the radiological features of low-grade extra-uterine ESS arising outside the uterus with a concomitant deep infiltrating endometriosis, but without the involvement of the endometrial cavity.
•Low-grade ESS, either uterine or extra-uterine, is a relative indolent variant of ESS.•Low-grade ESS is strongly associated with endometriosis.•Endometriosis tissue with T2 intermediate signal should be correlated with DWI/ADC and enhancement to assess cellularity. |
| doi_str_mv | 10.1016/j.clinimag.2020.08.015 |
| format | Article |
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Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine lesions, likely fibroids, and an endometrioma within the right ovary. The MRI of the pelvis with and without gadolinium identified a mass within the right ovary with homogenous intermediate T2-signal, restricted diffusion, and delayed enhancement relative to the myometrium. Several irregular-shaped lesions were also noted within the external myometrium, anterior pelvic wall, and the peritoneum, which were intermediate signal on T2-weighted images, restricted diffusion, and an enhancement pattern similar to the myometrium.
The patient underwent a right adnexectomy. The histopathology findings were consistent with a low-grade endometrial stromal sarcoma (low grade-ESS) arising from the endometrial stroma of the right ovary. A debulking surgery confirmed the involvement of external myometrium, anterior pelvic wall, and the peritoneum secondary to a low-grade ESS without the endometrial cavity's involvement.
The underlying hypothesis is that the endometriosis stroma from extra-uterine structures such as the right ovary, pelvic and anterior peritoneum, and external myometrium may have subsequently resulted in a low-grade ESS.
Low-grade extra-uterine ESS without endometrial involvement is a rare entity. Based on our literature search, this is one of the few reports covering the radiological features of low-grade extra-uterine ESS arising outside the uterus with a concomitant deep infiltrating endometriosis, but without the involvement of the endometrial cavity.
•Low-grade ESS, either uterine or extra-uterine, is a relative indolent variant of ESS.•Low-grade ESS is strongly associated with endometriosis.•Endometriosis tissue with T2 intermediate signal should be correlated with DWI/ADC and enhancement to assess cellularity.</description><identifier>ISSN: 0899-7071</identifier><identifier>EISSN: 1873-4499</identifier><identifier>DOI: 10.1016/j.clinimag.2020.08.015</identifier><language>eng</language><publisher>Philadelphia: Elsevier Inc</publisher><subject>Endometrial stromal sarcoma ; Endometriosis ; Endometrium ; Fibroids ; Gadolinium ; Gynecology ; Histopathology ; Image enhancement ; Laparoscopy ; Lesions ; Magnetic resonance imaging ; Metastasis ; Myometrium ; Oncology ; Ovaries ; Pain ; Pathology ; Patients ; Pelvis ; Peritoneum ; Sarcoma ; Stroma ; Surgery ; Ultrasound ; Uterus</subject><ispartof>Clinical imaging, 2020-11, Vol.67, p.250-254</ispartof><rights>2020 Elsevier Inc.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-c44218afb0942edfe61a346767238241b7512e2eb9347c9c3b3d6f898573825f3</citedby><cites>FETCH-LOGICAL-c373t-c44218afb0942edfe61a346767238241b7512e2eb9347c9c3b3d6f898573825f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0899707120303144$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids></links><search><creatorcontrib>Lipsich, Federico</creatorcontrib><creatorcontrib>Causa Andrieu, Pamela I.</creatorcontrib><creatorcontrib>Wernicke, Alejandra</creatorcontrib><creatorcontrib>Patrono, María Guadalupe</creatorcontrib><creatorcontrib>Napoli, Maria Noelia</creatorcontrib><creatorcontrib>Chacon, Carolina Rosa Beatriz</creatorcontrib><creatorcontrib>Nicola, Refky</creatorcontrib><title>Extra-uterine endometrial stromal sarcoma arising from deep infiltrating endometriosis</title><title>Clinical imaging</title><description>We present a compelling case of a 45-year-old female with a history of endometriosis and leiomyomas, who presented to her gynecologist with chronic pelvic pain complaints.
Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine lesions, likely fibroids, and an endometrioma within the right ovary. The MRI of the pelvis with and without gadolinium identified a mass within the right ovary with homogenous intermediate T2-signal, restricted diffusion, and delayed enhancement relative to the myometrium. Several irregular-shaped lesions were also noted within the external myometrium, anterior pelvic wall, and the peritoneum, which were intermediate signal on T2-weighted images, restricted diffusion, and an enhancement pattern similar to the myometrium.
The patient underwent a right adnexectomy. The histopathology findings were consistent with a low-grade endometrial stromal sarcoma (low grade-ESS) arising from the endometrial stroma of the right ovary. A debulking surgery confirmed the involvement of external myometrium, anterior pelvic wall, and the peritoneum secondary to a low-grade ESS without the endometrial cavity's involvement.
The underlying hypothesis is that the endometriosis stroma from extra-uterine structures such as the right ovary, pelvic and anterior peritoneum, and external myometrium may have subsequently resulted in a low-grade ESS.
Low-grade extra-uterine ESS without endometrial involvement is a rare entity. Based on our literature search, this is one of the few reports covering the radiological features of low-grade extra-uterine ESS arising outside the uterus with a concomitant deep infiltrating endometriosis, but without the involvement of the endometrial cavity.
•Low-grade ESS, either uterine or extra-uterine, is a relative indolent variant of ESS.•Low-grade ESS is strongly associated with endometriosis.•Endometriosis tissue with T2 intermediate signal should be correlated with DWI/ADC and enhancement to assess cellularity.</description><subject>Endometrial stromal sarcoma</subject><subject>Endometriosis</subject><subject>Endometrium</subject><subject>Fibroids</subject><subject>Gadolinium</subject><subject>Gynecology</subject><subject>Histopathology</subject><subject>Image enhancement</subject><subject>Laparoscopy</subject><subject>Lesions</subject><subject>Magnetic resonance imaging</subject><subject>Metastasis</subject><subject>Myometrium</subject><subject>Oncology</subject><subject>Ovaries</subject><subject>Pain</subject><subject>Pathology</subject><subject>Patients</subject><subject>Pelvis</subject><subject>Peritoneum</subject><subject>Sarcoma</subject><subject>Stroma</subject><subject>Surgery</subject><subject>Ultrasound</subject><subject>Uterus</subject><issn>0899-7071</issn><issn>1873-4499</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkE1LxDAQhoMouK7-BSl48dKarzbJTVn8ggUv6jWk6XRJ6bZrkor-e1NWPXjxNMPM-7zMvAidE1wQTKqrrrC9G9zWbAqKKS6wLDApD9CCSMFyzpU6RAsslcoFFuQYnYTQ4QQqLhbo9fYjepNPEbwbIIOhGbcQvTN9FqIft3M13qYmM94FN2yyNo2zBmCXuaF1fcLjPP5Fx-DCKTpqTR_g7Lsu0cvd7fPqIV8_3T-ubta5ZYLF3HJOiTRtjRWn0LRQEcN4JSpBmaSc1KIkFCjUinFhlWU1a6pWKlmKtC9btkSXe9-dH98mCFFvXbDQ92aAcQqaco6Tn0r6Jbr4I-3GyQ_pullFaInTSUlV7VXWjyF4aPXOp2j9pyZYz3HrTv_Eree4NZY6xZ3A6z0I6d13B14H62Cw0DgPNupmdP9ZfAE_N4xy</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Lipsich, Federico</creator><creator>Causa Andrieu, Pamela I.</creator><creator>Wernicke, Alejandra</creator><creator>Patrono, María Guadalupe</creator><creator>Napoli, Maria Noelia</creator><creator>Chacon, Carolina Rosa Beatriz</creator><creator>Nicola, Refky</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>202011</creationdate><title>Extra-uterine endometrial stromal sarcoma arising from deep infiltrating endometriosis</title><author>Lipsich, Federico ; Causa Andrieu, Pamela I. ; Wernicke, Alejandra ; Patrono, María Guadalupe ; Napoli, Maria Noelia ; Chacon, Carolina Rosa Beatriz ; Nicola, Refky</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-c44218afb0942edfe61a346767238241b7512e2eb9347c9c3b3d6f898573825f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Endometrial stromal sarcoma</topic><topic>Endometriosis</topic><topic>Endometrium</topic><topic>Fibroids</topic><topic>Gadolinium</topic><topic>Gynecology</topic><topic>Histopathology</topic><topic>Image enhancement</topic><topic>Laparoscopy</topic><topic>Lesions</topic><topic>Magnetic resonance imaging</topic><topic>Metastasis</topic><topic>Myometrium</topic><topic>Oncology</topic><topic>Ovaries</topic><topic>Pain</topic><topic>Pathology</topic><topic>Patients</topic><topic>Pelvis</topic><topic>Peritoneum</topic><topic>Sarcoma</topic><topic>Stroma</topic><topic>Surgery</topic><topic>Ultrasound</topic><topic>Uterus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lipsich, Federico</creatorcontrib><creatorcontrib>Causa Andrieu, Pamela I.</creatorcontrib><creatorcontrib>Wernicke, Alejandra</creatorcontrib><creatorcontrib>Patrono, María Guadalupe</creatorcontrib><creatorcontrib>Napoli, Maria Noelia</creatorcontrib><creatorcontrib>Chacon, Carolina Rosa Beatriz</creatorcontrib><creatorcontrib>Nicola, Refky</creatorcontrib><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lipsich, Federico</au><au>Causa Andrieu, Pamela I.</au><au>Wernicke, Alejandra</au><au>Patrono, María Guadalupe</au><au>Napoli, Maria Noelia</au><au>Chacon, Carolina Rosa Beatriz</au><au>Nicola, Refky</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extra-uterine endometrial stromal sarcoma arising from deep infiltrating endometriosis</atitle><jtitle>Clinical imaging</jtitle><date>2020-11</date><risdate>2020</risdate><volume>67</volume><spage>250</spage><epage>254</epage><pages>250-254</pages><issn>0899-7071</issn><eissn>1873-4499</eissn><abstract>We present a compelling case of a 45-year-old female with a history of endometriosis and leiomyomas, who presented to her gynecologist with chronic pelvic pain complaints.
Both a transvaginal ultrasound (US) and an MRI (magnetic resonance imaging) were ordered. The US demonstrated multiple uterine lesions, likely fibroids, and an endometrioma within the right ovary. The MRI of the pelvis with and without gadolinium identified a mass within the right ovary with homogenous intermediate T2-signal, restricted diffusion, and delayed enhancement relative to the myometrium. Several irregular-shaped lesions were also noted within the external myometrium, anterior pelvic wall, and the peritoneum, which were intermediate signal on T2-weighted images, restricted diffusion, and an enhancement pattern similar to the myometrium.
The patient underwent a right adnexectomy. The histopathology findings were consistent with a low-grade endometrial stromal sarcoma (low grade-ESS) arising from the endometrial stroma of the right ovary. A debulking surgery confirmed the involvement of external myometrium, anterior pelvic wall, and the peritoneum secondary to a low-grade ESS without the endometrial cavity's involvement.
The underlying hypothesis is that the endometriosis stroma from extra-uterine structures such as the right ovary, pelvic and anterior peritoneum, and external myometrium may have subsequently resulted in a low-grade ESS.
Low-grade extra-uterine ESS without endometrial involvement is a rare entity. Based on our literature search, this is one of the few reports covering the radiological features of low-grade extra-uterine ESS arising outside the uterus with a concomitant deep infiltrating endometriosis, but without the involvement of the endometrial cavity.
•Low-grade ESS, either uterine or extra-uterine, is a relative indolent variant of ESS.•Low-grade ESS is strongly associated with endometriosis.•Endometriosis tissue with T2 intermediate signal should be correlated with DWI/ADC and enhancement to assess cellularity.</abstract><cop>Philadelphia</cop><pub>Elsevier Inc</pub><doi>10.1016/j.clinimag.2020.08.015</doi><tpages>5</tpages></addata></record> |
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| ispartof | Clinical imaging, 2020-11, Vol.67, p.250-254 |
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| language | eng |
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| source | Elsevier ScienceDirect Journals |
| subjects | Endometrial stromal sarcoma Endometriosis Endometrium Fibroids Gadolinium Gynecology Histopathology Image enhancement Laparoscopy Lesions Magnetic resonance imaging Metastasis Myometrium Oncology Ovaries Pain Pathology Patients Pelvis Peritoneum Sarcoma Stroma Surgery Ultrasound Uterus |
| title | Extra-uterine endometrial stromal sarcoma arising from deep infiltrating endometriosis |
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