Low-grade endometrial stromal sarcoma: A Turkish uterine sarcoma group study analyzing prognostic factors and disease outcomes.

OBJECTIVE: To investigate factors associated with refractory disease, recurrence, or death as well as disease-free survival (DFS) and overall survival (OS) in low-grade endometrial sarcoma (LGESS). METHODS: A multi-institutional, retrospective study was conducted in a total of 124 patients, who received a curative-intent surgery. The exclusion criteria were as follows: i) history of any other invasive disease; ii) neoadjuvant therapy; iii) fertility sparing surgery; iv) a different diagnosis after review of the slides. RESULTS: All patients underwent hysterectomy, 96% had bilateral salpingo-oophorectomy, and 65% had lymphadenectomy. Twelve (14.8%) of 81 patients undergoing lymphadenectomy had lymph node (LN) metastasis. Of those, 8 (9.8%) had pelvic LN metastasis whereas 4 (5.6%) had isolated paraaortic LN metastasis. Six of 8 (75%) patients with positive pelvic LNs had concurrent paraaortic LN metastasis. Among 124 patients, 3 patients (2.4%) had refractory disease following primary therapy. During a median follow-up of 45.5 months, 27 (22.3%) of 121 patients who achieved complete remission after primary therapy developed recurrence, and 10 patients (8.1%) died of disease. The 3-year DFS and OS were 76.9% and 93.8%, respectively. Stage was the sole independent prognostic factor in the whole cohort. When analyzing factors within subgroups of stage I and stage ≥II, there was no significant prognostic factor for stage I; however, lymphadenectomy and adjuvant chemotherapy were significantly associated with disease outcomes for stage ≥II. While lymphadenectomy was related with improved DFS, chemotherapy was associated with poor DFS and OS. CONCLUSION: The risk of LN metastasis at pelvic as well as paraaortic lymphatic basins is not negligible to omit lymphadenectomy in stage ≥II LGESS. Moreover, lymphadenectomy provides significant DFS advantage in patients with extrauterine disease.

Úlcera eosinofílica lingual: un reto diagnóstico de patogénesis controvertida / Eosinophilic ulcer tongue: a diagnostic challenge controversial pathogenesis

La úlcera eosinofílica, también conocida como granuloma ulcerativo traumático con eosinofilia estromal, es una infrecuente y benigna lesión ulcerativa de la mucosa oral que presenta una evolución persistente, planteando a menudo diferentes diagnósticos clínicos diferenciales. Su diagnóstico se establece solo a partir del estudio histopatológico, si bien su morfología presenta a menudo características que pueden sugerir al patólogo la existencia de un proceso linfoproliferativo, traduciendo una patogénesis lesional controvertida todavía no bien aclarada. Comunicamos una observación clínico-patológica de úlcera eosinofílica afectando a una mujer de 76 años de edad. La lesión, de 2,5 cm de diámetro, afectaba al borde lateral lingual, siendo biopsiada en dos ocasiones, presentando tras un seguimiento clínico de 5 meses una evolución cicatricial, programándose actualmente un seguimiento clínico prologando de 24 meses. Se presentan las características morfológicas e inmunohistoquímicas del estudio biópsico, discutiendo las hipótesis patogéneticas que esta infrecuente lesión ulcerativa plantea(AU)

Eosinophilic ulcer, also know as traumatic ulcerative granuloma with stromal eosinophilia, is a rare and benign ulcerative lesion of oral mucosa that has a persistent progression, often requiring a differential clinical diagnosis. The diagnosis is only established from histopathological studies, which frequently show morphological features that may be suggestive of a lymphoproliferative process, resulting in a controversial pathogenesis that is still not clarified today. We report the clinical and pathological observations of an eosinophilic ulcer affecting a woman 76 year-old woman. A biopsy was performed twice on a 2.5 cm diameter ulcer affecting the lingual edge. After a clinical follow-up of 5 months, a self-limiting course with the production of a scar was verified. She has currently been scheduled for an extended 24-month clinical follow-up. The morphological and immunohistochemical features found in the biopsy study are presented, and the pathogenesis hypothesis of this uncommon ulcerative lesion is discussed(AU)

Endometrial stromal sarcoma: clinicopathological and immunophenotype study of 18 cases.

Malignant tumors of the uterine corpus are uncommon. They originate from the endometrial stroma, smooth muscle, blood vessels, or from a mixture of them. The objective of this article was to know the frequency and the clinical, morphologic, and immunophenotype characteristics of the endometrial stromal sarcoma (ESS). We reviewed the cases of ESS observed from 2002 to 2008 at the Pathology Unit of the General Hospital of Mexico. The following data were analyzed: age, clinical stage, degree of differentiation, and immunophenotype. We found 18 cases, and the average age of patients was 48.6 years; 66% were in clinical stages 1 and 2. Fifteen cases (83.3%) were classified as low-grade sarcomas and 3 (16.6%) as high-grade or undifferentiated sarcomas. We determined immunohistochemical markers in 17 cases; receptors to estrogens were positive in 5 (29.4%) and to progesterone in 9 (52.9%). CD10 was expressed in 10 (58.8%) and p53 in 11 cases (64.7%). Two cases were associated to primary tumors of the ovary (papillary cystadenocarcinoma). In conclusion, ESS was present at 0.6% in our institution; and most were low grade. Expression of markers, such as p53, CD10, and hormonal receptors, was positive.

Unexpected findings on gallium-67 scintigraphy: detection of undifferentiated endometrial stromal sarcoma.

We reported an extremely rare case of undifferentiated endometrial stromal sarcoma imaged with gallium-67 scintigraphy. This previously healthy 32-year-old woman presented with cough and dyspnea for days. Unexpectedly, the pathology of the opacity in the right pulmonary hilar region demonstrated metastatic high-grade epithelioid sarcoma. Gallium scintigraphy performed to detect possible origin showed abnormal uptake in the right supraclavicular region, chest region and pelvic region. Computed tomography-guided biopsy of the pelvic mass revealed undifferentiated endometrial stromal sarcoma. This case demonstrated the usefulness of gallium-67 scintigraphy in the detection of the primary disease and the evaluation of the metastatic disease.

Successful pregnancy after fertility-preserving surgery for endometrial stromal sarcoma.

OBJECTIVE: To report a case of successful pregnancy after treatment for endometrial stromal sarcoma. DESIGN: Case report. SETTING: Gynecology department at a provincial hospital affiliated with a university. PATIENT(S): A 25-year-old woman (gravida 0, para 0) with a misdiagnosis of myoma who received a pathologic diagnosis of endometrial stromal sarcoma after the first surgery. INTERVENTION(S): Second fertility-preserving surgery and chemotherapy. MAIN OUTCOME MEASURE(S): Successful pregnancy and follow-up visit. RESULT(S): After the conservative treatment, the patient entered complete remission. She conceived naturally and delivered at 39 weeks' gestation by caesarean section approximately 40 months after the surgery. CONCLUSION(S): Endometrial stromal sarcoma is a rare uterine tumor with a poor prognosis. This case shows that successful pregnancy is possible after effective conservative treatment by local surgical resection and adjunct chemotherapy.

Sarcoma de estroma endometrial metastático para cólon sigmóide e intestino delgado / Endometrial stroma sarcoma with metastasis to colon sigmoid and small bowel

Paciente de 46 anos de idade foi admitida com queixas gastrointestinais baixas e irregularidade menstrual. Os exames complementares e a laparotomia confirmaram o diagnóstico de sarcoma de estroma endometrial. O tratamento instituído foi a histerectomia total e anexectomia bilateral, colectomia esquerda ampliada e ressecçäo de segmento de íleo, local de metástase, além de terapia adjuvante com progestágeno e quimioterápicos. Os autores fazem uma revisäo da literatura e abordam os fatores prognósticos importantes nesta entidade clínica