endometrial stromal nodule

Endometrial Stromal Nodule (ESN) Description

An Endometrial Stromal Nodule (ESN) is a rare and benign tumor of the uterus, composed of cells reminiscent of proliferative phase endometrial stroma. It is characterized by its circumscribed nature, with minimal or no invasion into the myometrium (< 3 mm and < 3 protrusions), and lacks vascular invasion.

Key Features:

• Benign in nature
• Circumscribed growth pattern
• Minimal or no myometrial invasion (less than 3 mm and less than 3 protrusions)
• No vascular invasion
• Composed of cells similar to proliferative phase endometrial stroma

Distinguishing from Other Conditions:

ESNs must be differentiated from other invasive malignant stromal tumors, as well as low-grade endometrial stromal sarcomas (LGESS) and stromal sarcoma with limited infiltration in a hysterectomy specimen. The distinction is crucial for proper management and treatment.

References:

• [1] Endometrial stromal nodule has been defined as a well-circumscribed endometrial stromal tumor; however, focal irregularities or finger-like projections into the myometrium may be present (Source: [3])
• [5] ESN is described as a noninfiltrative, circumscribed proliferation of endometrial stromal cells and is a benign subtype of endometrial stromal tumors (Source: [6])
• [8] Endometrial stromal nodule (ESN) is a rare and benign tumor of endometrial stromal origin that accounts for less than 10% of uterine mesenchymal neoplasms (Source: [9])

Common Signs and Symptoms of Endometrial Stromal Nodule

Endometrial stromal nodules (ESNs) are rare tumors that can cause a range of symptoms in women. While some women may not show any signs or symptoms, others may experience:

• Irregular vaginal bleeding: This is the most common symptom of ESNs, and it can manifest as abnormal discharge from the vagina or heavy menstrual bleeding.
• Pelvic pain: Some women may experience pain in the pelvic region due to the tumor's growth.
• Uterine enlargement: As the tumor grows, it can cause the uterus to become larger than usual.
• Palpable mass: In some cases, a woman may be able to feel a lump or mass in her abdomen.

Other Possible Symptoms

While less common, other symptoms of ESNs include:

• Abnormal uterine bleeding: This can manifest as heavy menstrual bleeding or irregular vaginal discharge.
• Menorrhagia: Some women may experience prolonged or excessive menstrual bleeding due to the tumor's growth.
• Compression of adjoining organ structures: Large tumors can cause compression of surrounding organs, leading to symptoms such as pelvic pain or discomfort.

Important Note

It is essential to note that not all women with ESNs will experience these symptoms. Some women may be asymptomatic, and the only indication of the tumor's presence may be an abnormal uterine mass during a routine gynecological examination.

References:

• [6] Abnormal bleeding from the vagina, such as: · Abnormal discharge from the vagina · Pain in the pelvic or stomach region · A lump that you can feel
• [7] The most common symptom of ESS is irregular vaginal bleeding. Asymptomatic uterine enlargement, pelvic pain, or a palpable mass are also common symptoms.
• [10] What are the Signs and Symptoms of Endometrial Stromal Nodule? Some women may not show any signs and symptoms. In others, the signs and symptoms of Endometrial Stromal Nodule may include: The presence of a typically solitary tumor that can grow to large sizes; The tumor size may range from 1 cm to 22 cm; average size of 7 cm
• [14] The tumors may be painless and asymptomatic, in some cases. Some women may have pelvic pain and abnormal or heavy bleeding. Tumors that grow to large sizes can cause signs and symptoms due to compression of adjoining organ structures;

Diagnostic Testing for Endometrial Stromal Nodule

Endometrial stromal nodules are rare benign tumors that can be challenging to diagnose. The diagnosis is often made through a combination of clinical evaluation, imaging studies, and histopathological examination.

• Imaging Studies: Imaging tests such as ultrasound, MRI, or

The differential diagnosis for endometrial stromal nodules (ESNs) includes several conditions that can mimic the appearance and behavior of ESNs. Some of these differential diagnoses are:

• Cellular leiomyoma: This is a type of benign tumor that can be difficult to distinguish from ESNs, especially when viewed under a microscope. However, cellular leiomyomas typically have a more fascicular growth pattern and may contain large or thick-walled blood vessels [3].
• Low-grade endometrial stromal sarcoma (LG-ESS): This is a type of malignant tumor that can be challenging to differentiate from ESNs due to overlapping morphological features and immunohistochemical profiles. However, LG-ESS typically has more aggressive behavior and may invade the myometrium [4].
• High-grade endometrial stromal sarcoma (HG-ESS): This is a type of malignant tumor that can be distinguished from ESNs by its more aggressive behavior and higher grade of differentiation.
• Undifferentiated uterine sarcoma (UUS): This is a rare and aggressive type of cancer that can be difficult to distinguish from ESNs due to overlapping morphological features.

To make an accurate diagnosis, it's essential to consider the clinical presentation, histopathological findings, and immunohistochemical profiles of the tumor. For example, CD10 positivity and desmin negativity can help differentiate ESNs from cellular leiomyomas [11].

References:

[3] - The vascular pattern of ESN, composed of typical arterioles, is not a prominent feature of cellular leiomyoma. [4] - Low-grade endometrial stromal sarcoma typically has more aggressive behavior and may invade the myometrium. [11] - CD10 positivity and desmin negativity can help differentiate ESNs from cellular leiomyomas.