Case Report
Volume 11 Issue 1 - 2022
Uterine Sarcoma; An Unusual Presentation - Case Report and a Literature Review
Khalid Ali*, Shagufta Rafiq, Fauzi Alhakmi, Samia Azad, Ibrahim Abbasher, Nageen Naseer and Raouf Sallam
St. Luke’s General Hospital, Kilkenny, Ireland
*Corresponding Author: Khalid Ali, St. Luke’s General Hospital, Kilkenny, Ireland.
Received: December 15, 2021; Published: December 27, 2021


Uterine sarcomas are a rare heterogeneous group of tumours accounting for approximately 1% of all female genital tract malignancies and 8% of all uterine malignancies, a notably higher proportion than previous estimates of 2 - 3% [1]. This increased incidence may be explained by improved diagnostics, accompanied by a true increase of incidence in the ageing population [1]. We present a case of uterine sarcoma in a 49-year-old woman, mother of three, who presented initially with menorrhagia. Her examination under anaesthesia (EUA), hysteroscopy, and dilatation and curettage (D and C) revealed no significant abnormalities. The endometrium looked unremarkable and a Mirena coil was inserted. She continued to have persistent symptoms and a pelvic ultrasound scan revealed a 5 cm fibroid.

Ten months later, the patient presented again with heavy bleeding per vagina. An urgent pelvic ultrasound showed a significant increase in the fibroid size, now measuring 10.3 x 11.3 x 10 cm. No other pelvic or abdominal abnormalities were noted, with the Mirena coil remaining in situ. The patient agreed to start LHRHa injections for symptomatic management, however this had little impact and she presented again three months later, still in significant pain. Her abdomen was distended with a large pelvi-abdominal mass reaching the level of the umbilicus. She was considered for an urgent laparotomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). Laparotomy revealed an enlarged uterus reaching the umbilical level, with multiple metastatic lesions covering the uterine surface, bowel, and omentum. The planned surgical intervention was abandoned, and multiple biopsies were taken. CT-TAP was performed and revealed distant widespread metastases. Palliative treatment was decided after discussion with the multidisciplinary team (MDT), patient, and immediate family.

Keywords: Uterine Sarcoma; Endometrial Stromal Sarcoma; ESS; Leiomyoma; Fibroid; Laparotomy; Bleeding


  1. Major FJ., et al. “Prognostic factors in early-stage uterine sarcoma: A gynecologic oncology group study”. CancerS4 (1993): 1702-1709.
  2. Prat J. “FIGO staging for uterine sarcomas”. International Journal of Gynecology and Obstetrics 3 (2008): 177-178.
  3. Lavie O., et al. “The risk of developing uterine sarcoma after tamoxifen use”. International Journal of Gynecological Cancer 2 (2008): 352-356.
  4. Mbatani N., et al. “Uterine sarcomas”. International Journal of Gynecology and Obstetrics 143 (2018) 51-58.
  5. Oliva E. “Cellular Mesenchymal Tumors of the Uterus: A Review Emphasizing Recent Observations”. International Journal of Gynecological Pathology 4 (2014): 374-384.
  6. Roberts ME., et al. “Uterine leiomyosarcoma: A review of the literature and update on management options”. Gynecologic Oncology 3 (2018): 562-572.
  7. Zhang Y., et al. “High-grade endometrial stromal sarcoma: a retrospective study of factors influencing prognosis”. Cancer Management and Research 11 (2019) 831-837.
  8. Hanby AM., et al. “Pathology and Genetics: Tumours of the Breast and Female Genital Organs”. WHO Classification of Tumours series - volume IV. Lyon, France: IARC Press. Breast cancer research: BCR 6.3 (2004).
  9. Puliyath G and Nair MK. “Endometrial stromal sarcoma: A review of the literature”. Indian Journal of Medical and Paediatric Oncology 1 (2012): 1-6.
  10. Miettinen M. “Modern Soft Tissue Pathology. Cambridge medicine1st edition ed. New York: Cambridge University Press (2010).
  11. Jain R., et al. “Low grade endometrial stromal sarcoma: a case report”. Iranian Journal of Medical Sciences1 (2015): 81-84.
  12. Jin Y., et al. “Clinical Characteristics of Endometrial Stromal Sarcoma from an Academic Medical Hospital in China”. International Journal of Gynecological Cancer 9 (2010): 1535-1539.
  13. Rauh-Hain J and Carmen Md. “Endometrial Stromal Sarcoma: A Systematic Review”. Obstetrics and Gynecology (New York.1953) 122.3 (2013): 676-683.
  14. Li N., et al. “Treatment options in stage I endometrial stromal sarcoma: A retrospective analysis of 53 cases”. Gynecologic Oncology 2 (2007): 306-311.
  15. Thomas MB., et al. “Endometrial Stromal Sarcoma: Treatment and Patterns of Recurrence”. International Journal of Gynecological Cancer 2 (2009): 253-256.
  16. Burke C and Hickey K. “Treatment of Endometrial Stromal Sarcoma with a Gonadotropin-Releasing Hormone Analogue”. Obstetrics and Gynecology (New York. 1953) 104.5 (2004): 1182-1184.
  17. Reich O and Regauer S. “Hormonal therapy of endometrial stromal sarcoma”. Current Opinion in Oncology 4 (2007): 347-352.
  18. Velden Jvd and Buist MR. “Endometrial Stromal Sarcoma: Treatment and Patterns of Recurrence”. International Journal of Gynecological Cancer19.5 (2009): 989.
  19. Grimer R., et al. “Guidelines for the Management of Soft Tissue Sarcomas”. Sarcoma 2010 (2010): 506182.
  20. Spano J., et al. “Long-term survival of patients given hormonal therapy for metastatic endometrial stromal sarcoma”. Medical Oncology (Northwood, London, England)1 (2003): 87-94.
  21. Weitmann HD., et al. “Radiation therapy in the treatment of endometrial stromal sarcoma”. International Journal of Radiation Oncology, Biology, Physics3 (2001): 739-748.
  22. Amant F., et al. “Clinical management of uterine sarcomas”. The lancet Oncology12 (2009): 1188-1198.
  23. Geller MA., et al. “Treatment and recurrence patterns in endometrial stromal sarcomas and the relation to c-kit expression”. Gynecologic Oncology3 (2004): 632-636.
  24. Riopel J., et al. “Lymph node metastases in low-grade endometrial stromal sarcoma”. Gynecologic Oncology2 (2005): 402-406.
  25. Chan JK., et al. “Endometrial stromal sarcoma: a population-based analysis”. British Journal of Cancer8 (2008): 1210-1215.
Citation: Khalid Ali., et al. “Uterine Sarcoma; An Unusual Presentation - Case Report and a Literature Review”. EC Gynaecology 11.1 (2022): 45-49.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

February Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the February issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before February 23, 2023.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.