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Endometrial Stromal Sarcoma Arising from Endometrial Polyp: A Case Report
Saki Sato1, Yojiro Ojima1, Masatoshi Kanda1
1Department of Obstetrics and Gynecology, Sanda City Hospital, Sanda, Japan.
The Kobe Journal of Medical Sciences
|November 2, 2018
Summary
This case report details an unusual endometrial stromal sarcoma (ESS) with both low-grade and high-grade components originating from an endometrial polyp. Immunohistochemistry proved vital for accurate diagnosis of this rare uterine malignancy.
Area of Science:
- Gynecologic Oncology
- Pathology
- Oncologic Imaging
Background:
- Endometrial stromal sarcoma (ESS) is a rare uterine malignancy.
- This report presents a unique case of ESS arising from an endometrial polyp, exhibiting both low-grade and high-grade histological features.
Observation:
- Magnetic resonance imaging and contrast computed tomography initially suggested a uterine malignant tumor.
- Macroscopic examination revealed a polypoid lesion within the uterine cavity, identified as an endometrial polyp with ESS components.
- Immunohistochemistry demonstrated differential expression of CD10, estrogen receptor (ER), and progesterone receptor (PR) between low-grade and high-grade ESS components.
Findings:
- Low-grade ESS and the endometrial polyp showed positivity for CD10, ER, and PR.
- High-grade ESS exhibited focal, weak CD10 positivity and lacked ER and PR expression.
- Elevated Ki-67 and p53 proliferation markers were observed in high-grade ESS, alongside smooth muscle actin and desmin positivity in both grades.
Implications:
- Immunohistochemical analysis is crucial for accurately diagnosing ESS with mixed grades, aiding in distinguishing it from benign conditions.
- Accurate diagnosis facilitated by immunohistochemistry can guide treatment decisions for rare uterine tumors.
- This case highlights the importance of comprehensive histopathological evaluation in managing complex gynecologic malignancies.
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