The diagnostic problem of endometrial stromal sarcoma: report on six cases

Objective. The objective was to look for the incidence and clinicopathologic findings of women in whom the diagnosis of endometrial stromal sarcoma was initially missed. Methods. We carried out a retrospective analysis of cases treated at our institution from 1990 to 2002. Results. In 6/15 (40%) women suffering from endometrial stromal sarcoma, the diagnosis initially was missed. The first diagnosis was uterine leiomyoma (n = 2), myxoid leiomyoma (n = 2), cellular leiomyoma (n = 1), or lymphatic disorder (n = 1). The final diagnosis was only made after consultation of a pathologist with a special interest in gynecological oncology. The mean age of this group was only 34 years (range, 18-53). A mean delay in diagnosis of 143 months (range, 24-408) resulted in stage 4 disease in 5/6 women. After a mean follow-up of 16 years (range, 5-43), 4/6 are without macroscopic evidence of disease, 1/6 with evidence of disease, and 1/6 died of disease. Conclusion. Especially in younger women, the diagnosis of endometrial stromal sarcoma can be problematic. (C) 2003 Elsevier Science (USA). All rights reserved.