Zhang Ying, Wei Zhiyong, Yan Jia, Xie Keliang, Wang Zhiqiang
Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.
Transl Cancer Res. 2022 Sep;11(9):3421-3425. doi: 10.21037/tcr-22-317.
Endometrial stromal sarcoma (ESS) is a uterine stromal tumor with a very low incidence, accounting for 10-15% of all uterine stromal malignancies and 0.2% of all uterine malignancies. The most common extrauterine location of ESS is the ovary, and it is relatively rare outside the uterus. Although most recurrences occur within the pelvis, distant metastases can occur.
We report a rare case of low-grade ESS (LG-ESS) metastatic to the inferior vena cava (IVC) which is difficult to distinguish from leiomyoma clinically. A 56-year-old woman attended outpatient complaining right thigh pain. She underwent a surgery of hysterectomy and bilateral adnexectomy 12 years ago. Abdominal contrast-enhanced computed tomography (CT) demonstrated that the vaginal stump was thick, with peripheral multiple nodular shadow. Soft tissue shadow in the right pelvic cavity. Thickening and enhancement of soft tissue shadow were observed in the peripheral blood vessels of the vaginal stump, the right internal iliac vein and the external iliac vein to the IVC of the liver segment. Malignancy (recurrence or metastasis) were considered. After multidisciplinary consultant, a preoperative diagnosis of leiomyomatosis of the IVC was made and surgical treatment was performed. Surgeons performed laparotomy, resection of tumor in IVC, right common iliac vein, right external iliac vein, right internal iliac vein and left common iliac vein. Post-operative pathology of dissected tumor demonstrated LG-ESS. The source may be the ovarian venous stump left after surgery 12 years ago. After a gynecological consultant, chemotherapy is recommended and is currently under follow-up.
We report a rare case of LG-ESS metastatic to the IVC, which was probably a lesion derived from the ovarian venous stump remaining after surgery 12 years ago.
子宫内膜间质肉瘤（ESS）是一种发病率极低的子宫间质肿瘤，占所有子宫间质恶性肿瘤的10 - 15%，占所有子宫恶性肿瘤的0.2%。ESS最常见的子宫外部位是卵巢，在子宫外相对罕见。虽然大多数复发发生在盆腔内，但也可发生远处转移。
我们报告一例罕见的低级别ESS（LG - ESS）转移至下腔静脉（IVC）的病例，该病例在临床上难以与平滑肌瘤区分。一名56岁女性因右大腿疼痛前来门诊就诊。她12年前接受了子宫切除术和双侧附件切除术。腹部增强计算机断层扫描（CT）显示阴道残端增厚，周围有多个结节状阴影。右盆腔有软组织阴影。阴道残端外周血管、右髂内静脉及从髂外静脉至肝段下腔静脉的软组织阴影增厚并强化。考虑为恶性病变（复发或转移）。经过多学科会诊，术前诊断为下腔静脉平滑肌瘤病并进行了手术治疗。外科医生进行了剖腹手术，切除了下腔静脉、右髂总静脉、右髂外静脉、右髂内静脉和左髂总静脉内的肿瘤。切除肿瘤的术后病理显示为LG - ESS。其来源可能是12年前手术后残留的卵巢静脉残端。经过妇科会诊，建议进行化疗，目前正在随访中。
我们报告了一例罕见的LG - ESS转移至下腔静脉的病例，其可能是源于12年前手术后残留的卵巢静脉残端的病变。
