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Endometrial Stromal Sarcoma
Douglas Rogers, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Uterine sarcoma
          • Definitions

            • Malignant mesenchymal tumor of endometrium
            • 4 categories of endometrial stromal tumor
              • Endometrial stromal nodule (benign)
              • Low-grade endometrial stromal sarcoma (LGSS)
              • High-grade endometrial stromal sarcoma (HGSS)
              • Undifferentiated stromal sarcoma (USS)
                • Many cases are likely misdiagnosed HGSS

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Cotzia P et al: Undifferentiated uterine sarcomas represent under-recognized high-grade endometrial stromal sarcomas. Am J Surg Pathol. 43(5):662-9, 2019
                                          2. Huang YT et al: Current status of magnetic resonance imaging in patients with malignant uterine neoplasms: a review. Korean J Radiol. 20(1):18-33, 2019
                                          3. Kim TH et al: What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration? J Gynecol Oncol. 29(3):e26, 2018
                                          4. Seagle BL et al: Low-grade and high-grade endometrial stromal sarcoma: a National Cancer Database study. Gynecol Oncol. 146(2):254-62, 2017
                                          5. Yoon A et al: Prognostic factors and outcomes in endometrial stromal sarcoma with the 2009 FIGO staging system: a multicenter review of 114 cases. Gynecol Oncol. 132(1):70-5, 2014
                                          6. Tirumani SH et al: Current concepts in the imaging of uterine sarcoma. Abdom Imaging. 38(2):397-411, 2013
                                          7. Seddon BM et al: Uterine sarcomas--recent progress and future challenges. Eur J Radiol. 78(1):30-40, 2011
                                          8. Tse KY et al: Staging of uterine sarcomas. Best Pract Res Clin Obstet Gynaecol. 25(6):733-49, 2011
                                          9. Wu TI et al: Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Pract Res Clin Obstet Gynaecol. 25(6):681-9, 2011
                                          10. Chew I et al: Endometrial stromal sarcomas: a review of potential prognostic factors. Adv Anat Pathol. 17(2):113-21, 2010
                                          11. Fujii S et al: Diffusion-weighted imaging of uterine endometrial stromal sarcoma: a report of 2 cases. J Comput Assist Tomogr. 34(3):377-9, 2010
                                          12. Furukawa R et al: Endometrial stromal sarcoma located in the myometrium with a low-intensity rim on T2-weighted images: report of three cases and literature review. J Magn Reson Imaging. 31(4):975-9, 2010
                                          13. Sohaib SA et al: Imaging of uterine malignancies. Semin Ultrasound CT MR. 31(5):377-87, 2010
                                          14. Nugent EK et al: The value of perioperative imaging in patients with uterine sarcomas. Gynecol Oncol. 115(1):37-40, 2009
                                          15. Moinfar F et al: Uterine sarcomas. Pathology. 39(1):55-71, 2007
                                          16. Kusaka M et al: A case of high-grade endometrial stromal sarcoma arising from endometriosis in the cul-de-sac. Int J Gynecol Cancer. 16(2):895-9, 2006
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Uterine sarcoma
                                                  • Definitions

                                                    • Malignant mesenchymal tumor of endometrium
                                                    • 4 categories of endometrial stromal tumor
                                                      • Endometrial stromal nodule (benign)
                                                      • Low-grade endometrial stromal sarcoma (LGSS)
                                                      • High-grade endometrial stromal sarcoma (HGSS)
                                                      • Undifferentiated stromal sarcoma (USS)
                                                        • Many cases are likely misdiagnosed HGSS

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Cotzia P et al: Undifferentiated uterine sarcomas represent under-recognized high-grade endometrial stromal sarcomas. Am J Surg Pathol. 43(5):662-9, 2019
                                                                                  2. Huang YT et al: Current status of magnetic resonance imaging in patients with malignant uterine neoplasms: a review. Korean J Radiol. 20(1):18-33, 2019
                                                                                  3. Kim TH et al: What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration? J Gynecol Oncol. 29(3):e26, 2018
                                                                                  4. Seagle BL et al: Low-grade and high-grade endometrial stromal sarcoma: a National Cancer Database study. Gynecol Oncol. 146(2):254-62, 2017
                                                                                  5. Yoon A et al: Prognostic factors and outcomes in endometrial stromal sarcoma with the 2009 FIGO staging system: a multicenter review of 114 cases. Gynecol Oncol. 132(1):70-5, 2014
                                                                                  6. Tirumani SH et al: Current concepts in the imaging of uterine sarcoma. Abdom Imaging. 38(2):397-411, 2013
                                                                                  7. Seddon BM et al: Uterine sarcomas--recent progress and future challenges. Eur J Radiol. 78(1):30-40, 2011
                                                                                  8. Tse KY et al: Staging of uterine sarcomas. Best Pract Res Clin Obstet Gynaecol. 25(6):733-49, 2011
                                                                                  9. Wu TI et al: Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Pract Res Clin Obstet Gynaecol. 25(6):681-9, 2011
                                                                                  10. Chew I et al: Endometrial stromal sarcomas: a review of potential prognostic factors. Adv Anat Pathol. 17(2):113-21, 2010
                                                                                  11. Fujii S et al: Diffusion-weighted imaging of uterine endometrial stromal sarcoma: a report of 2 cases. J Comput Assist Tomogr. 34(3):377-9, 2010
                                                                                  12. Furukawa R et al: Endometrial stromal sarcoma located in the myometrium with a low-intensity rim on T2-weighted images: report of three cases and literature review. J Magn Reson Imaging. 31(4):975-9, 2010
                                                                                  13. Sohaib SA et al: Imaging of uterine malignancies. Semin Ultrasound CT MR. 31(5):377-87, 2010
                                                                                  14. Nugent EK et al: The value of perioperative imaging in patients with uterine sarcomas. Gynecol Oncol. 115(1):37-40, 2009
                                                                                  15. Moinfar F et al: Uterine sarcomas. Pathology. 39(1):55-71, 2007
                                                                                  16. Kusaka M et al: A case of high-grade endometrial stromal sarcoma arising from endometriosis in the cul-de-sac. Int J Gynecol Cancer. 16(2):895-9, 2006