Endometrial stromal sarcoma diagnosed by operative hysteroscopy

A 33 year old, para-2 woman had a 'submucous myoma' diagnosed in the uterine fundus during a diagnostic hysteroscopy because of dysfunctional bleeding. After pretreatment with a gonadotrophin-releasing hormone (GnRH) agonist for 3 months, the myoma was resected through a resectoscope. Histological examination showed features of low-grade stromal sarcoma although no complete diagnostic certainty was reached. Due to the age of the patient and her wish to preserve fertility, it was decided not to perform extensive surgery but to perform hysteroscopy again in a follow-up visit after 3 months. Since the myoma had by this time recurred in the same place, it was decided to perform a total abdominal hysterectomy. The subsequent histopathological examination confirmed the growth of a low-grade stromal sarcoma. Following this diagnosis, the ovaries were removed laparoscopically and were found to be free of tumour.