Endometrial Stromal Sarcoma: A Rare Tumor Case Report

Endometrial stromal sarcomas (ESSs) are rare malignant tumors of the uterus.Endometrial stromal sarcoma primarily affects peri-and postmenopausal women and often presents with nonspecific symptoms like abnormal uterine bleeding (AUB), making early diagnosis challenging.We report a case of a 46-year-old perimenopausal woman who presented with heavy menstrual bleeding for 2 years, associated with fatigue, weight loss, and loss of appetite.Clinical and radiological evaluation initially suggested a diagnosis of uterine leiomyoma.Magnetic resonance imaging (MRI) and computed tomography (CT) imaging revealed a well-defined lobulated lesion in the lower endometrial cavity with loss of the endomyometrial interface.Endometrial aspiration suggested a low-grade spindle cell tumor.The patient underwent staging laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy.Histopathology confirmed low-grade endometrial stromal sarcoma (LG-ESS), stage IB, with lymphovascular invasion.Immunohistochemistry was positive for CD10, vimentin, and progesterone receptors with a low Ki-67 index.Though lymph nodes and peritoneum were uninvolved, a subsequent positron emission tomography (PET) scan revealed distant metastases to the liver and spine, and the patient succumbed to metastatic disease.This case highlights the diagnostic difficulty in ESS, which often mimics benign leiomyomas preoperatively.Imaging modalities such as MRI can aid in suspicion, but definitive diagnosis requires histopathological and immunohistochemical analysis.Endometrial stromal sarcomas should be considered in the differential diagnosis of AUB, even in younger perimenopausal women.Early recognition and appropriate surgical intervention are crucial for improving outcomes in these rare uterine malignancies.The case underscores the importance of high clinical suspicion and comprehensive diagnostic evaluation in managing ESS.