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Aggressive endometriosis: report of a case
R.A. Scolyer1, J. Carter, P. Russell
1Departments of Anatomical Pathology and Gynaecological Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
Summary
A patient with a history of uterine sarcoma developed new pelvic lesions. These lesions were benign endometriosis, not a recurrence, leading to the proposed term "aggressive endometriosis".
Area of Science:
- Gynecologic Oncology
- Pathology
- Reproductive Endocrinology
Background:
- A 54-year-old woman with a history of low-grade endometrial stromal sarcoma presented with symptoms suggestive of recurrence.
- Previous treatment included vaginal hysterectomy 4 years prior.
Purpose of the Study:
- To investigate the cause of new abdominal symptoms and elevated CA-125 levels in a patient with a history of uterine sarcoma.
- To characterize the nature of newly discovered pelvic lesions and determine their relationship to the prior malignancy.
Main Methods:
- Laparotomy was performed to evaluate abdominal pain, constipation, and elevated serum CA-125.
- Histopathological examination of ovarian cyst, meso-ovarian nodule, and pericolic abscess.
- Morphological comparison between current lesions and the original endometrial stromal sarcoma.
Main Results:
- Findings included a benign ovarian endometrioid cystadenoma, a pericolic abscess due to diverticular disease, and a left adnexal nodule with florid endometriosis.
- The endometriosis involved vascular spaces and appeared to be of recent onset.
- No lesions resembled the original uterine sarcoma, and no evidence of endometriosis was found elsewhere.
Conclusions:
- The pelvic lesions were morphologically distinct from the prior uterine sarcoma, suggesting no pathogenetic relationship.
- The term "aggressive endometriosis" is proposed to describe these florid, vascular-invasive benign endometrial changes.
- The patient recovered well and is monitored with tumor markers.