Pulmonary Metastasizing Low-Grade Endometrial Stromal Sarcoma: Case Report and Review of Diagnostic Pitfalls

Pulmonary manifestations of benign metastasizing leiomyoma (BML) usually include multiple well-defined, round, bilateral nodules. Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine tumor. A 70-year-old woman visited the clinic complaining of acute cough and dyspnea in April 2017. Chest...

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Bibliographic Details
Published in:Diagnostics (Basel) 2022-01, Vol.12 (2), p.271
Main Authors: Kim, Geon Woo, Baek, Sun Kyung, Han, Jae Joon, Kim, Hong Jun, Sung, Ji-Youn, Maeng, Chi Hoon
Format: Article
Language:English
Subjects:
benign metastasizing leiomyoma
Biopsy
Case Report
Case reports
Dyspnea
endometrial stromal tumor
Fibroids
Gynecology
Hospitals
Hysterectomy
letrozole
Lungs
Medical screening
Metastasis
Oophorectomy
Pleural effusion
Pneumothorax
Sarcoma
Smooth muscle
Surgery
Tumors
Womens health
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Summary:Pulmonary manifestations of benign metastasizing leiomyoma (BML) usually include multiple well-defined, round, bilateral nodules. Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine tumor. A 70-year-old woman visited the clinic complaining of acute cough and dyspnea in April 2017. Chest computed tomography (CT) revealed pneumothorax and multiple pulmonary nodules. She had a history of hysterectomy for uterine leiomyoma 23 years ago. Biopsy revealed that the pulmonary masses were consistent with BML. However, the patient had two subsequent episodes of acute, recurrent respiratory distress, accompanied by massive pleural effusions and hydropneumothorax over the next two years. A chest CT performed for acute dyspnea revealed large and multiple hydropneumothoraces. The size and distribution of pulmonary masses were aggravated along with cystic changes and bilateral pleural effusions. Given this aggressive feature, additional immunohistochemical findings and gynecologic pathologist review confirmed the correct diagnosis to be LG-ESS. After initiating anti-estrogen therapy, the patient achieved a partial response, without recurrence of symptoms, for 28 months. Metastatic LG-ESS responds well to anti-hormonal therapy. If the clinical pattern of a disease is different than expected, the possibility of a correction in the diagnosis should be considered.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics12020271