Address for Correspondence Case Report A rare case of endometrial stromal sarcoma

Endometrial stromal sarcoma is rare, comprising 10 % of the uterine mesenchymal tumors, and one-half of women affected are postmenopausal. They are classified into endometrial stromal nodule and endometrial stromal sarcoma that are low-grade malignant tumors of uterus. They are indolent tumors with local recurrences and distant metastasis occurring even 20 years after initial diagnosis. Most endometrial stromal sarcomas stained positively for CD10, estrogen receptor, progesterone receptor, and bcl-2, mostly in a diffuse pattern. The present case is of a 45 years female patient presented with abdominal pain and irregular menstruation, white discharge, bleeding per vagina for last six months. She had undergone tubectomy 6 years ago. Per abdominal examination revealed distended abdomen with aversion of umbilicus. There was no evidence of free fluid in the abdomen. Ultrasonography was carried out which revealed a bulky uterus with solid lesion in the myometrium showing heterogenous echo texture. Total vaginal hysterectomy was carried out and the specimen was sent to department of pathology. Grossly, the uterus was large, globular and firm. The cut-section shows bulky tumour, greywhite-to-yellow nodular mass in colour, with infiltrating margins, measuring about 5.0 X 5.0 X 4.0 cms. The endometrium is distorted by the tumour. Microscopically, the uterus showed tumour composed of small-to-medium sized cells, round-to-oval & spindle shaped cells with large hyperchromatic nuclei and occasional mitosis, small amount of cytoplasm. These tumour cells are showing infiltrating margins, focal necrosis, hemorrhage, local invasion and lymphatic emboli. Immunohistochemistry showed CD 10, Estrogen, and Progesterone receptors positive. It was confirmed that as endometrial stromal sarcomas which is presented here for its rarity. Key-words: Uterus, endometrial stromal sarcoma, low grad