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Table of Contents
CLINICAL IMAGE
Year : 2020  |  Volume : 9  |  Issue : 4  |  Page : 251-252

Recurrent low-grade endometrial stromal sarcoma presenting as isolated pedunculated vaginal cuff polyp


1 Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
2 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
3 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan

Date of Submission09-May-2018
Date of Decision23-Aug-2019
Date of Acceptance04-Aug-2020
Date of Web Publication15-Oct-2020

Correspondence Address:
Dr. Kuan- Gen Huang
No. 5, Fu-Hsin Street, Kwei-Shan, Tao-Yuan 333
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_42_18

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How to cite this article:
Tantitamit T, Chang SH, Huang KG. Recurrent low-grade endometrial stromal sarcoma presenting as isolated pedunculated vaginal cuff polyp. Gynecol Minim Invasive Ther 2020;9:251-2

How to cite this URL:
Tantitamit T, Chang SH, Huang KG. Recurrent low-grade endometrial stromal sarcoma presenting as isolated pedunculated vaginal cuff polyp. Gynecol Minim Invasive Ther [serial online] 2020 [cited 2020 Oct 23];9:251-2. Available from: https://www.e-gmit.com/text.asp?2020/9/4/251/298135



A 53-year-old female presented with a history of abnormal vaginal bleeding. She had a total laparoscopic hysterectomy and bilateral salpingectomy for preoperative diagnosis of myoma uteri. All specimens were removed through the vagina without bag by manual morcellation. Postoperative diagnosis was low-grade endometrial stromal sarcoma (LGESS). Thus, she underwent bilateral oophorectomy and pelvic and para-aortic lymphadenectomy. Final diagnosis showed LGESS spread to the left ovary and left adnexa, which was consistent with FIGO Stage IIA. The patient was treated with 6 courses of Adriamycin and ifosfamide. Six years later, the pelvic examination found a polypoid mass at the left angle of a vaginal stump that proved to be LGESS metastasis after the biopsy [Figure 1]. The magnetic resonance imaging (MRI) revealed no evidence of recurrence in the pelvic cavity, distant metastasis, or lymph node enlargement. Laparoscopic wide local resection was performed and confirmed recurrent LGESS over the left vaginal cuff. The treatment response is evaluated by a pelvic examination and a  Pap smear More Details of the vaginal cuff every 3 months and magnetic resonance (MRI) every 6 months. She is currently disease free 1 year after surgery.
Figure 1: Large polypoid mass at the left angle of the vaginal stump

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Recurrence of low-grade endometrial stromal sarcomas is rare. The interval before recurrence varies from 3 months to 23 years, with a median interval of 34 months.[1],[2] The recurrence rate was 16%–43% among patients who had bilateral salpingo-oophorectomy at initial treatment.[1] The disease mainly spreads to the pelvis, followed by vagina and lung. Prolonged survival and even cure are common after surgical resection of recurrent or metastatic lesions.[3],[4] Long-term follow is essential to ensure early detection of recurrence with intent to improve survival. One study reported four cases of vault recurrence in early-stage uterine and ovarian malignancy after laparoscopic surgery. One patient underwent laparoscopic hysterectomy for fibroids, which later turned out to be a uterine sarcoma. All these specimens were removed through the vagina, which led to implantation of malignant cells.[5] In this case, the method of specimen retrieval may be a significant risk of vault recurrence. We need to emphasize the importance of preoperative evaluation of patients with high-risk uterine sarcoma and specimen retrieval in the bag should be strictly adhere.

Ethical approval

This study was approved by Institutional Review Board of Chang Gung Medical Foundation (IRB number: 202000863B0). Waiver of informed consent was approved by the IRB.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yokosuka K, Kumagai M, Aiba S. Low-grade endometrial stromal sarcoma recurring after 9 years. South Med J 2002;95:1196-200.  Back to cited text no. 1
    
2.
Ashraf-Ganjoei T, Behtash N, Shariat M, Mosavi A. Low grade endometrial stromal sarcoma of uterine corpus, a clinico-pathological and survey study in 14 cases. World J Surg Oncol 2006;4:50.  Back to cited text no. 2
    
3.
Nam JH. Surgical treatment of uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 2011;25:751-60.  Back to cited text no. 3
    
4.
Thomas MB, Keeney GL, Podratz KC, Dowdy SC. Endometrial stromal sarcoma: Treatment and patterns of recurrence. Int J Gynecol Cancer 2009;19:253-6.  Back to cited text no. 4
    
5.
Chitrathara K, Khan A, Sreedharan N, Shriya N, Raj S. Vaginal vault metastasis– The new enigma in port site recurrences in gynecological laparoscopic surgeries. Gynecol Minimal Invas Ther 2016;5:116-9.  Back to cited text no. 5
    


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