Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous Woman
<b>Background and Clinical Significance:</b> Low-grade endometrial stromal sarcoma (LGESS) is a rare uterine malignancy that causes non-specific symptoms which presents more typically in younger women compared to other uterine sarcomas. Preoperative diagnosis of myometrial LGESS is chall...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-12-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/15/1/18 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841549311814402048 |
|---|---|
| author | Hyun Kyung Lee Weon Jang Kyoung Min Kim Ji Soo Song |
| author_facet | Hyun Kyung Lee Weon Jang Kyoung Min Kim Ji Soo Song |
| author_sort | Hyun Kyung Lee |
| collection | DOAJ |
| description | <b>Background and Clinical Significance:</b> Low-grade endometrial stromal sarcoma (LGESS) is a rare uterine malignancy that causes non-specific symptoms which presents more typically in younger women compared to other uterine sarcomas. Preoperative diagnosis of myometrial LGESS is challenging, as it is frequently mistaken for a benign uterine mass, such as a degenerating leiomyoma. Despite its rarity, the imaging findings of LGESS are highly variable, complicating the diagnostic process. Characteristic findings on magnetic resonance imaging T2-weighted imaging (T2WI)—including intra-tumoral low signal intensity (SI) bands (correlating with preserved myometrial bundles separated by tumor cells on histopathology), cystic/necrotic changes, and absence of a speckled appearance—have been significantly associated with LGESS. Additionally, apparent diffusion coefficient mapping can aid in the characterization of uterine masses. <b>Case Presentation</b>: We present a case of LGESS initially misdiagnosed as red degeneration of a uterine leiomyoma (RDL) due to a peripheral rim showing high SI on T1-weighted imaging and low SI on T2WI, which was interpreted as a thrombosed vessel. Histopathology demonstrated necrotic tissue outlined by normal uterine tissue, corresponding to the peripheral rim. We suggest that susceptibility-weighted imaging could have aided in distinguishing between the two conditions due to its high sensitivity to blood products. Moreover, diffusion-weighted imaging revealed restriction along T2 low SI bands, with no restrictions within the bands themselves, potentially indicating a viable tumor along preserved myometrium. <b>Conclusions</b>: These imaging features may provide valuable insights for diagnosing LGESS and differentiating it from RDL, supporting further research on LGESS imaging characteristics. |
| format | Article |
| id | doaj-art-eb3645d4dc7f4aaba978e38e29b89da5 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-eb3645d4dc7f4aaba978e38e29b89da52025-01-10T13:16:27ZengMDPI AGDiagnostics2075-44182024-12-011511810.3390/diagnostics15010018Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous WomanHyun Kyung Lee0Weon Jang1Kyoung Min Kim2Ji Soo Song3Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Jeonbuk, Republic of KoreaDepartment of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Jeonbuk, Republic of KoreaResearch Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Jeonbuk, Republic of KoreaDepartment of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Jeonbuk, Republic of Korea<b>Background and Clinical Significance:</b> Low-grade endometrial stromal sarcoma (LGESS) is a rare uterine malignancy that causes non-specific symptoms which presents more typically in younger women compared to other uterine sarcomas. Preoperative diagnosis of myometrial LGESS is challenging, as it is frequently mistaken for a benign uterine mass, such as a degenerating leiomyoma. Despite its rarity, the imaging findings of LGESS are highly variable, complicating the diagnostic process. Characteristic findings on magnetic resonance imaging T2-weighted imaging (T2WI)—including intra-tumoral low signal intensity (SI) bands (correlating with preserved myometrial bundles separated by tumor cells on histopathology), cystic/necrotic changes, and absence of a speckled appearance—have been significantly associated with LGESS. Additionally, apparent diffusion coefficient mapping can aid in the characterization of uterine masses. <b>Case Presentation</b>: We present a case of LGESS initially misdiagnosed as red degeneration of a uterine leiomyoma (RDL) due to a peripheral rim showing high SI on T1-weighted imaging and low SI on T2WI, which was interpreted as a thrombosed vessel. Histopathology demonstrated necrotic tissue outlined by normal uterine tissue, corresponding to the peripheral rim. We suggest that susceptibility-weighted imaging could have aided in distinguishing between the two conditions due to its high sensitivity to blood products. Moreover, diffusion-weighted imaging revealed restriction along T2 low SI bands, with no restrictions within the bands themselves, potentially indicating a viable tumor along preserved myometrium. <b>Conclusions</b>: These imaging features may provide valuable insights for diagnosing LGESS and differentiating it from RDL, supporting further research on LGESS imaging characteristics.https://www.mdpi.com/2075-4418/15/1/18endometrial stromal sarcomaleiomyomamagnetic resonance imagingdiffusion-weighted imageapparent diffusion coefficient |
| spellingShingle | Hyun Kyung Lee Weon Jang Kyoung Min Kim Ji Soo Song Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous Woman Diagnostics endometrial stromal sarcoma leiomyoma magnetic resonance imaging diffusion-weighted image apparent diffusion coefficient |
| title | Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous Woman |
| title_full | Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous Woman |
| title_fullStr | Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous Woman |
| title_full_unstemmed | Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous Woman |
| title_short | Low-Grade Endometrial Stromal Sarcoma: A Case Report of a Rare Uterine Malignancy Mimicking Degenerative Uterine Leiomyoma in a Nulliparous Woman |
| title_sort | low grade endometrial stromal sarcoma a case report of a rare uterine malignancy mimicking degenerative uterine leiomyoma in a nulliparous woman |
| topic | endometrial stromal sarcoma leiomyoma magnetic resonance imaging diffusion-weighted image apparent diffusion coefficient |
| url | https://www.mdpi.com/2075-4418/15/1/18 |
| work_keys_str_mv | AT hyunkyunglee lowgradeendometrialstromalsarcomaacasereportofarareuterinemalignancymimickingdegenerativeuterineleiomyomainanulliparouswoman AT weonjang lowgradeendometrialstromalsarcomaacasereportofarareuterinemalignancymimickingdegenerativeuterineleiomyomainanulliparouswoman AT kyoungminkim lowgradeendometrialstromalsarcomaacasereportofarareuterinemalignancymimickingdegenerativeuterineleiomyomainanulliparouswoman AT jisoosong lowgradeendometrialstromalsarcomaacasereportofarareuterinemalignancymimickingdegenerativeuterineleiomyomainanulliparouswoman |