Serdar KİRMİZİ, Bercıs İmge UCAR, Sevda YİLMAZ, Demet AYDOGAN KİRMİZİ

Düşük dereceli endometrial stromal sarkomun mideye metastazı

Endometrial stromal sarkomlar (ESS) nadir karşılaşılan uterusun mezenkimal tümörleridir. Low Grade Endometrial Stromal Sarkom (LGESS) ESS’ların yaklaşık üçte ikisini oluşturur. LGESS metastazı çok uzun yıllar sonra görülebilir. Dispeptik şikayetler nedeniyle yapılan tetkiklerde 57 yaşındaki bayan hastanın endoskopik incelenmesinde mide antrumda mezenşimal tümör saptandı. Hastanın vajinal kanama nedeniyle onbeş yıl önce histerektomi ve unilateral oferektomi yapıldığı ve LGESS tanısı aldığı öğrenildi. Kontrastlı bilgisayarlı tomografide (BT) mide de yaklaşık 5 cm çapında kitle saptandı. Subtotal gastrektomi ve omentektomi uygulandı, immunohistolojik incelemede LGESS olarak raporlandı. Bildiğimiz kadarıyla primer uterus kaynaklı LGESS’ın mideye metastazı saptanan ilk olgu olma özelliği taşımaktadır. LGESS’ın çok uzun yıllar sonra midenin gastrointestinal stromal tümörleriyle karışabilecek metastatik kitle ile karşımıza çıkabileceği akılda tutulmalıdır.

Anahtar Kelimeler:

Endometrial stromal sarkom, gastrointestinal stromal tümör, mide, metastaz

Stomach metastasis of low-grade endometrial stromal sarcoma

Endometrial stromal sarcomas (ESS) are rare mesenchymal tumors of the uterus. Low-grade endometrial stromal sarcoma (LGESS) constitutes approximately two-thirds of ESS. Metastasis of LGESS can be seen after many years. In the endoscopic examination, a 57-year-old female patient with dyspeptic complaints was diagnosed with mesenchymal originated tumor located in the antrum of the stomach. It is reported that the patient underwent a hysterectomy and unilateral oophorectomy 15 years ago due to vaginal bleeding. A mass in the stomach approximately 5 cm in diameter was detected in the abdominal contrast-enhanced computed tomography. She underwent subtotal gastrectomy and omentectomy, and immunohistological examination was reported as LGESS. As far as we know, it is the first case reported as a LGESS metastasis to stomach so far. We should bear in mind that metastasis of LGESS may be seen after many years. It should be included in differential diagnosis of gastrointestinal stromal tumors

Keywords:

Endometrial stromal sarcoma, gastrointestinal stromal tumor, stomach, metastasis,

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References1- Amant F, Coosemans A, Debiec-Rychter M, Timmerman D, Vergote I. Clinical management of uterine sarcomas. Lancet Oncol 2009; 10: 1188-98.
2- Kim L, Choi SJ, Park IS, et al. Endometrial stromal sarcoma of the small bowel. Ann Diagn Pathol 2008; 12: 128–33.
3-Bai H, Yang J, Cao D, et al. Ovary and uterus sparing procedures for low-grade endometrial stromal sarcoma: A retrospective study of 153 cases. Gynecolojic oncology 2014; 132: 654–60.
4- Koh WJ, Abu-Rustum NR, Bean S, et al. Uterine neoplasms, version 1.2018, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network 2018; 16(2): 170-199.
5- Heaps JM, Nieberg RK, Berek JS. Malignant neoplasms arising in endometriosis. Obstetrics and Gynecology 1990; 75: 1023–28.
6- Kalkmann J, Zeile M, Antoch G, et al. Consensus report on the radiological management of patients with gastrointestinal stromal tumours (GIST): recommendations of the German GIST Imaging Working Group. Cancer Imaging 2012; 12: 126–35.
7- Zhu Q, Sun YQ, Di X Q, Huang B, Huang, J. Metastatic low-grade endometrial stromal sarcoma with sex cord and smooth muscle differentiation: A case report. World journal of clinical cases 2019; 7(2): 221.
8- Argadjendra M, Ahmadi N, Varol C. A Case of Retroperitoneal Metastases That Occur 14 Years After Surgery. Urology case reports 2016; 9: 21-23.
9- Kethu SR, Zheng S, Eid R. Metastatic low-grade endometrial stromal sarcoma presented as a subepithelial mass in the stomach was diagnosed by EUS-guided FNA. Gastrointestinal endoscopy 2005; 62: 814-16.