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Endometrial stromal sarcoma of the sigmoid colon: a case report and literature review

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Abstract

Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus that accounts for 7–25% of uterine sarcomas and < 1% of uterine tumors. Previously reported sites include the ovary, bowel wall, abdomen, peritoneum, pelvis, and vagina; however, ESS in the extrauterine area is rare. We report a rare case of endometrial stromal sarcoma that developed in the sigmoid colon along the gonadal vasculature, which was difficult to distinguish from colon cancer. A large polyp was found in the sigmoid colon of a 74-year-old woman during a routine medical examination and was diagnosed as tubular adenoma. On colonoscopy 7 months later, the tumor had grown and blocked the lumen, causing stenosis. She was referred to our hospital for surgery. Although detailed examination at our hospital did not yield a definitive diagnosis, bowel obstruction was considered likely and we performed laparoscopic low anterior resection under a preoperative diagnosis of sigmoid colon cancer. The tumor protruded into the sigmoid colon from the stump of the ovarian arteries and veins outside the intestinal tract. As the left ovarian artery and vein were involved in the tumor, we extracted them as a lump. The tumor was diagnosed as low-grade ESS (LG-ESS). She had a history of hysterectomy and left salpingo-oophorectomy for uterine myoma 25 years ago, and radiation therapy was performed after surgery for an unknown reason. The postoperative course was uneventful, and follow-up was continued at the request of the patient. We report a rare case of ESS infiltrating the sigmoid colon, which was probably a lesion derived from endometriosis of the ovarian arteriovenous stump remaining after surgery 25 years ago.

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Abbreviations

ESS:

Endometrial stromal sarcoma

LG-ESS:

Low-grade endometrial stromal sarcoma

CEA:

Carcinoembryonic antigen

ER:

Estrogen receptor

UUS:

Undifferentiated uterine sarcoma

GIST:

Gastrointestinal stromal tumor

PR:

Progesterone receptor

References

  1. Zhang YY, Li Y, Qin M, Cai Y, Jin Y, Pan LY (2019) High-grade endometrial stromal sarcoma: a retrospective study of factors influencing prognosis. Cancer Manag Res 11:831–837

    Article  Google Scholar 

  2. Puliyath G, Nair VR, Singh S (2010) Endometrial stromal sarcoma. Indian J Med Paediatr Oncol 31(1):21–23

    Article  Google Scholar 

  3. Zagouri F, Dimopoulos A-M, Fotiou S, Kouloulias V, Papadimitriou CA (2009) Treatment of early uterine sarcomas: disentangling adjuvant modalities. World J Surg Oncol 7(1):38

    Article  Google Scholar 

  4. Gadducci A, Cosio S, Romanini A, Genazzani AR (2008) The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 65(2):129–142

    Article  Google Scholar 

  5. Masand RP, Euscher ED, Deavers MT, Malpica A (2013) Endometrioid stromal sarcoma: a clinicopathologic study of 63 cases. Am J Surg Pathol 37(11):1635–1647

    Article  Google Scholar 

  6. Conklin CM, Longacre TA (2014) Endometrial stromal tumors: the new WHO classification. Adv Anat Pathol 21(6):383–393

    Article  CAS  Google Scholar 

  7. Hosh M, Antar S, Nazzal A, Warda M, Gibreel A, Refky B (2016) Uterine sarcoma: analysis of 13,089 cases based on surveillance, epidemiology, and end results database. Int J Gynecol Cancer 26(6):1098–1104

    Article  Google Scholar 

  8. Harlow BL, Weiss NS, Lofton S (1986) The epidemiology of sarcomas of the uterus. J Natl Cancer Inst 76(3):399–402

    CAS  PubMed  Google Scholar 

  9. Denschlag D, Thiel FC, Ackermann S, Harter P, Juhasz-Boess I, Mallmann P et al (2015) Sarcoma of the uterus. Guideline of the DGGG (S2k-level, AWMF registry no. 015/074, August 2015). Geburtshilfe Frauenheilkd 75(10):1028–1042

    Article  CAS  Google Scholar 

  10. Thiel FC, Halmen S (2018) Low-grade endometrial stromal sarcoma—a review. Oncol Res Treat 41(11):687–692

    Article  Google Scholar 

  11. Hoang L, Chiang S, Lee CH (2018) Endometrial stromal sarcomas and related neoplasms: new developments and diagnostic considerations. Pathology 50(2):162–177

    Article  CAS  Google Scholar 

  12. Meredith RF, Eisert DR, Kaka Z, Hodgson SE, Johnston GA Jr, Boutselis JG (1986) An excess of uterine sarcomas after pelvic irradiation. Cancer 58(9):2003–2007

    Article  CAS  Google Scholar 

  13. Amant F, Coosemans A, Debiec-Rychter M, Timmerman D, Vergote I (2009) Clinical management of uterine sarcomas. Lancet Oncol 10(12):1188–1198

    Article  Google Scholar 

  14. Lan C, Huang X, Lin S, Cai M, Liu J (2012) Endometrial stromal sarcoma arising from endometriosis: a clinicopathological study and literature review. Gynecol Obstet Invest 74(4):288–297

    Article  Google Scholar 

  15. Son HJ, Kim JH, Kang DW, Lee HK, Park MJ, Lee SY (2015) Primary extrauterine endometrial stromal sarcoma in the sigmoid colon. Ann Coloproctol 31(2):68–73

    Article  Google Scholar 

  16. Lee CH, Mariño-Enriquez A, Ou W, Zhu M, Ali RH, Chiang S et al (2012) The clinicopathologic features of YWHAE-FAM22 endometrial stromal sarcomas: a histologically high-grade and clinically aggressive tumor. Am J Surg Pathol 36(5):641–653

    Article  Google Scholar 

  17. Goff BA, Rice LW, Fleischhacker D, Muntz HG, Falkenberry SS, Nikrui N et al (1993) Uterine leiomyosarcoma and endometrial stromal sarcoma: lymph node metastases and sites of recurrence. Gynecol Oncol 50(1):105–109

    Article  CAS  Google Scholar 

  18. Thomas MB, Keeney GL, Podratz KC, Dowdy SC (2009) Endometrial stromal sarcoma: treatment and patterns of recurrence. Int J Gynecol Cancer 19(2):253–256

    Article  Google Scholar 

  19. Reich O, Singer C, Hudelist G, Regauer S (2007) Estrogen sulfotransferase expression in endometrial stromal sarcomas: an immunohistochemical study. Pathol Res Pract 203(2):85–87

    Article  CAS  Google Scholar 

  20. Nam JH (2011) Surgical treatment of uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 25(6):751–760

    Article  Google Scholar 

  21. Bernstein-Molho R, Grisaro D, Soyfer V, Safra T, Merimsky O (2010) Metastatic uterine leiomyosarcomas: a single-institution experience. Int J Gynecol Cancer 20(2):255–260

    Article  Google Scholar 

  22. Leitao MM, Brennan MF, Hensley M, Sonoda Y, Hummer A, Bhaskaran D et al (2002) Surgical resection of pulmonary and extrapulmonary recurrences of uterine leiomyosarcoma. Gynecol Oncol 87(3):287–294

    Article  Google Scholar 

  23. Moinfar F, Azodi M, Tavassoli FA (2007) Uterine sarcomas. Pathology 39(1):55–71

    Article  Google Scholar 

  24. Baiocchi G, Kavanagh JJ, Wharton JT (1990) Endometrioid stromal sarcomas arising from ovarian and extraovarian endometriosis: report of two cases and review of the literature. Gynecol Oncol 36(1):147–151

    Article  CAS  Google Scholar 

  25. Yantiss RK, Clement PB, Young RH (2000) Neoplastic and pre-neoplastic changes in gastrointestinal endometriosis: a study of 17 cases. Am J Surg Pathol 24(4):513–524

    Article  CAS  Google Scholar 

  26. Bosincu L, Massarelli G, Rocca PC, Isaac MA, Nogales FF (2001) Rectal endometrial stromal sarcoma arising in endometriosis: report of a case. Dis Colon Rectum 44(6):890–892

    Article  CAS  Google Scholar 

  27. Mourra N, Tiret E, Parc Y, de Saint-Maur P, Parc R, Flejou JF (2001) Endometrial stromal sarcoma of the rectosigmoid colon arising in extragonadal endometriosis and revealed by portal vein thrombosis. Arch Pathol Lab Med 125(8):1088–1090

    Article  CAS  Google Scholar 

  28. Cho HY, Kim MK, Cho SJ, Bae JW, Kim I (2002) Endometrial stromal sarcoma of the sigmoid colon arising in endometriosis: a case report with a review of literatures. J Korean Med Sci 17(3):412–414

    Article  Google Scholar 

  29. Kovac D, Gasparović I, Jasic M, Fuckar D, Dobi-Babić R, Haller H (2005) Endometrial stromal sarcoma arising in extrauterine endometriosis: a case report. Eur J Gynaecol Oncol 26(1):113–116

    CAS  PubMed  Google Scholar 

  30. Asada Y, Isomoto H, Akama F, Nomura N, Wen CY, Nakao H et al (2005) Metastatic low-grade endometrial stromal sarcoma of the sigmoid colon three years after hysterectomy. World J Gastroenterol 11(15):2367–2369

    Article  Google Scholar 

  31. Chen CW, Ou JJ, Wu CC, Hsiao CW, Cheng MF, Jao SW (2007) High-grade endometrial stromal sarcoma arising from colon endometriosis. Int J Colorectal Dis 22(12):1551–1553

    Article  Google Scholar 

  32. Li CH, Chang WC (2011) Recurrent endometrial stromal sarcoma in the cecum causing intussusception. Arch Gynecol Obstet 283(4):899–901

    Article  Google Scholar 

  33. Ayuso A, Fadare O, Khabele D (2013) A case of extrauterine endometrial stromal sarcoma in the colon diagnosed three decades after hysterectomy for benign disease. Case Rep Obstet Gynecol 2013:202458

    PubMed  PubMed Central  Google Scholar 

  34. Bakker IS, Hoven-Gondrie ML, Moll FC, de Haan HH (2013) A very late recurrence of a formerly misdiagnosed low grade endometrial stromal sarcoma metastasized to the colon. Int J Surg Case Rep 4(12):1113–1116

    Article  Google Scholar 

  35. Chowdri NA, Mehraj A, Parray FQ, Khan MA, Laharwal MA, Wani RA (2018) Endometrial stromal sarcoma recurrence in the caecum. Case Rep Surg 2018:9139281

    PubMed  PubMed Central  Google Scholar 

  36. Ahn SR, Lee JH (2020) Low-grade endometrial stromal sarcoma presenting as a sigmoid mass. Korean J Gastroenterol 76(6):322–326

    Article  Google Scholar 

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Acknowledgements

We thank Dr. Daniel Mrozek: President of Medical English Service for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 860-0008, Japan

    Takuya Tajiri, Kosuke Mima, Kosuke Kanemitsu, Toru Takematsu, Keisuke Kosumi, Mitsuhiro Inoue, Takao Mizumoto, Tatsuo Kubota & Nobutomo Miyanari

  2. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Kosuke Mima & Hideo Baba

  3. Department of Pathological Diagnosis, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 860-0008, Japan

    Reiji Muto & Toshihiko Murayama

Authors
  1. Takuya Tajiri
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  2. Kosuke Mima
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  3. Kosuke Kanemitsu
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  4. Toru Takematsu
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  11. Nobutomo Miyanari
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Contributions

TT described and designed the article. KM edited the article. NM supervised editing of the manuscript. The other co-authors collected the data and discussed the content of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideo Baba.

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Written informed consent was received from the patient for publication of this case report and any accompanying images.

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Tajiri, T., Mima, K., Kanemitsu, K. et al. Endometrial stromal sarcoma of the sigmoid colon: a case report and literature review. Int Canc Conf J 10, 294–299 (2021). https://doi.org/10.1007/s13691-021-00493-z

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  • DOI: https://doi.org/10.1007/s13691-021-00493-z

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