Key result
One-stage surgical resection achieves favorable early locoregional control in metastatic intracardiac endometrial stromal sarcoma.
Why the study?
Metastasis of low-grade endometrial stromal sarcoma to the inferior vena cava and right atrium is exceptionally rare and presents significant diagnostic and therapeutic challenges.
Case Report (n=1)
Aggressive one-stage surgical management with cardiopulmonary bypass is a viable and effective strategy for achieving locoregional control in advanced low-grade endometrial stromal sarcoma with extensive inferior vena cava and cardiac metastasis.
Answers are grounded in this paper and cite their sources.
Suggests feasibility of aggressive resection for rare cardiac metastases; hypothesis-generating and should not yet change practice.
Low-grade endometrial stromal sarcoma (LGESS) is a rare uterine malignancy; metastasis to the inferior vena cava (IVC) and right atrium is exceptionally rare and presents significant diagnostic and therapeutic challenges. We report the case of a 37-year-old woman presenting with progressive abdominal mass enlargement, palpitations, and dyspnea. She had undergone a hysteroscopic resection for presumed uterine myoma one year prior, which was subsequently re-evaluated as LGESS. Multimodal imaging comprising 18 F-FDG PET/CT, MRI, CT, and echocardiography was implemented for systemic staging and hemodynamic assessment, then revealed a solid uterine mass involving the adnexa (FIGO Stage IVB) and identified hypermetabolic tumor thrombi extending from the IVC into the right atrium and pulmonary arteries. A coordinated one-stage radical resection was performed, involving total hysterectomy and removal of intracardiac thrombi under cardiopulmonary bypass. Postoperative pathology and immunohistochemistry confirmed LGESS (CD10+, ER+, PR+) with extensive lymphovascular invasion. The patient recovered uneventfully with no residual disease on follow-up and commenced adjuvant letrozole therapy. This case highlights the necessity of multimodal imaging for accurate staging of complex vascular involvement and demonstrates that aggressive one-stage surgical management is a viable strategy to achieve locoregional control and favorable early outcomes for advanced LGESS with cardiac metastasis.
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Tu et al. (2026) conducted a case report in Low-grade endometrial stromal sarcoma with metastasis to the inferior vena cava and right atrium (n=1). One-stage surgical resection was evaluated on Clinical recovery and disease-free status. One-stage surgical resection successfully achieved locoregional control and favorable early outcomes in a patient with advanced low-grade endometrial stromal sarcoma metastatic to the heart.
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