Treatment of endometrial stromal sarcoma with a gonadotropin-releasing hormone analogue

BACKGROUND: Endometrial stromal sarcoma can present management difficulties due to its lack of response to conventional chemotherapy and radiotherapy. Various hormonal therapies have been shown to reduce tumor volume in both primary and recurrent disease. CASE: A woman who underwent myomectomy was discovered to have a low-grade endometrial stromal sarcoma. Treatment with the gonadotropin-releasing hormone (GnRH) analogue triptorelin before surgery had produced reduction in uterine size. The woman developed tumor recurrence six months after definitive surgical treatment. The tumor enlarged rapidly during a 2-month period, with development of a right-sided hydronephrosis. Repeat administration of triptorelin was accompanied by resolution of the hydronephrosis and reduction in tumor volume. Biopsy results confirmed recurrent low-grade endometrial stromal sarcoma with moderate estrogen and progesterone receptor positivity. CONCLUSION: Control of progression of a recurrent endometrial stromal sarcoma was achieved with the GnRH analogue triptorelin. This is the first report in the English-language literature during a 30-year period of single-agent GnRH analogue being an effective treatment intervention in this context.