A 31-year-old female with endometrial stromal cell sarcoma developed catastrophic lung collapse and tracheal invasion due to pulmonary metastases after years of aromatase inhibitor nonadherence.
Case Report (n=1)
This case demonstrates a rare presentation of Endometrial Stromal Cell Sarcoma with progressive pulmonary metastases leading to lung collapse and tracheal invasion.
Abstract Introduction Endometrial Stromal Cell Tumors are mesenchymal tumors that can occur as Endometrial Stromal Nodules, Endometrial Stromal Cell Sarcoma (ESS), and Undifferentiated Stromal Cell Sarcoma (UES). The incidence of ESS is 1 to 2 per million women per year1 and metastatic spread most commonly occurs through the abdomen and pelvis but rarely metastasizes to the lungs. When present, pulmonary metastases can occur years to even decades after initial diagnosis, most commonly as pulmonary nodule(s).2 Case In 2011, a 31 year old female with abnormal uterine bleeding was diagnosed with ESS and underwent a Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy in 2012. She was started on Aromatase Inhibitor (AI) therapy which she was inadherent to and lost to follow up until 2017, when follow up revealed a RLL lung nodule with CT guided biopsy showing atypical spindle and fibrous infiltrates suggestive of stromal cell etiology. In 2018, a CT scan found an unresectable right Bronchus Intermedius (BI) endobronchial tumor extending into the right mainstem bronchus, with compression of the SVC. A CT scan in 2021 noted complete collapse of the right lower lobe and right middle lobe, and a left upper lobe (LUL) pulmonary nodule. In the setting of continued AI inadherence for multiple years, the patient presented to the Emergency Department in June 2025 after several days of increasing dyspnea and new stridor, requiring High Flow Nasal Cannula. CT demonstrated the BI mass as measuring 12.2cm with new extension into the trachea and carina, along with tracheal deviation with near complete obliteration of tracheal lumen. Agreement was made to proceed with palliative tumor debulking and the patient was cannulated for V-V ECMO for ventilatory support during rigid bronchoscopy. Mass was debulked to the level of carina, patient was decannulated, and later underwent LUL nodule biopsy. All tracheal tumor biopsies were indeterminate showing fibrin and inflammatory necrosis, however biopsy of the LUL nodule was consistent with metastatic spread of ESS. Code status was changed to do not resuscitate and patient is transitioning to comfort care. Discussion ESS is a rare uterine malignancy with pulmonary metastases being uncommon. Roughly 50% of patient with pulmonary metastases have no obvious symptoms and present with pulmonary nodules, or rarely an incidental mass.3 Progressive metastatic growth is uncommon with ESS characterized by indolent growth and responsiveness to AI therapy .4,5 No prior reports have been found demonstrating lung collapse or tracheal invasion due to ESS. This abstract is funded by: None
Moyer et al. (Fri,) conducted a case report in Endometrial Stromal Cell Sarcoma (ESS) metastatic to the lungs (n=1). Aromatase Inhibitor therapy and palliative tumor debulking was evaluated. A 31-year-old female with endometrial stromal cell sarcoma developed catastrophic lung collapse and tracheal invasion due to pulmonary metastases after years of aromatase inhibitor nonadherence.