title: Detection of pulmonary metastasis of low-grade endometrial stromal sarcoma 25 years after hysterectomy.
abstract: Endometrial stromal sarcoma (ESS) is a rare uterine sarcoma. Low-grade ESS occasionally recurs or metastasizes after long disease-free periods, a fact that may complicate the diagnosis. Here we report a case of multiple lung metastases in a 68-year-old woman who had been disease-free for 25 years after hysterectomy for a uterine tumor. Biopsy revealed that the tumor was composed of oval cells with slight nuclear atypism but without mitotic figures, suggesting a low-grade neoplasm. Immunostaining for intermediate filaments revealed strong positivity for vimentin and weak positivity for alpha-smooth muscle actin. In addition, immunostaining for estrogen and progesterone receptors, performed under suspicion of low-grade ESS, was positive. The uterine tumor resected many years before had shown a similar morphology. Thus, it was demonstrated that the lung neoplasm was a metastatic low-grade ESS that had appeared after many disease-free years. A review of the literature revealed that this case had the longest recorded interval between the occurrence of the initial ESS and the development of distant metastases. When low-grade sarcoma appears in the lungs of female patients, it is important to consider the possibility of low-grade ESS. Detailed information on the past clinical history, together with immunostaining for estrogen and progesterone receptors, are important diagnostic keys.
authors.affiliation: Department of Pathology, Yokohama City University School of Medicine, Japan. y-ina@urahp.yokohama-cu.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Inayama
authors.forename: A
authors.initials: A
authors.lastname: Shoji
authors.forename: S
authors.initials: S
authors.lastname: Odagiri
authors.forename: F
authors.initials: F
authors.lastname: Hirahara
authors.forename: T
authors.initials: T
authors.lastname: Ito
authors.forename: N
authors.initials: N
authors.lastname: Kawano
authors.forename: Y
authors.initials: Y
authors.lastname: Nakatani
mesh_terms: D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary*; D008875:Middle Aged; D013902:Radiography, Thoracic; D018203:Sarcoma, Endometrial Stromal / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D014057:Tomography, X-Ray Computed