engleski

Low grade sromal sarcoma (ESS) arising within uterine leiomyoma: a case report.

Objective: ESS is a rare neoplasm usually arising in the endometrium composed of uniform, oval to fusiform cells with scant cytoplasm that resemble proliferative endometrial stroma. Method: A 61-year old woman underwent routine abdominal hysterectomy with bilateral salpingo- oophorectomy due to abdominal mass and vaginal bleeding. Macroscopic and histological examining revealed an enlarged uterus with numerous fibroids except one that contained „nodes within node“. There were also enlarged ovaries, endometrial polyp of usual type, and hyperplastic endometrium. „Nodes within node“ consists of solid cords and clusters of hypercellular tissue that is reminiscent of proliferating endometrial stroma and sex-cord- stromal-like areas. Foci are surrounded by bundles of smooth muscle cells which do not differ from those in other fibroids of the same uterus. There was no connection of these foci with endometrium. Foci of adenomyosis in the myometrium were not found. There was lympho- vascular invasion. Immunohistochemical examination was made. Foci showed immunohistochemical positivity for vimentin, S- 100, CD99, calretinin, α inhibin, CK7, CKMNF116, EMA, CD10, WT1, MelanA, CD117 and Cyclin D1 while negative for SMA and desmin. Conclusion: Although it is known from the literature that ESS may exhibit differentiation towards the ovarian sex-cord-stromal-like elements and smooth muscle differentiation, in this case it is obvious that ESS grows within the smooth muscle tumour without connection to the endometrium or adenomyosis. It seems that in the occurrence of tumours such as this stem cells have a crucial role as thay have the potential of differentiation in various directions when they are appropriately stimulated. Bilateral stromal hyperplasia of the ovaries with persistent ovarian hormone secretion should be considered as a possible factor of influence on the stem cells differentiation. In this case there are morphological changes that suggest ovarian hormonal activity as endometrial hyperplasia, glandular polyp of the endometrium and numerous leiomyoma.

uterus ; leiomyoma, endometrial stromal sarcoma

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