endometrial stromal tumor

Common Signs and Symptoms of Endometrial Stromal Tumor

Endometrial stromal tumors are rare forms of uterine cancer that can cause a range of symptoms, which may vary from one person to another. The most common symptom is irregular vaginal bleeding, including:

• Bleeding or spotting between periods
• Vaginal bleeding after menopause
• Abnormal uterine bleeding (i.e., bleeding that is not part of the menstrual cycle)

Other possible symptoms include:

• Pelvic pain
• Abdominal pain
• Feeling a mass (tumor) in the pelvis
• Losing weight without trying

It's essential to note that these symptoms may also be indicative of other, less serious conditions. Therefore, if you experience any unusual vaginal bleeding or pelvic pain, it's crucial to seek medical guidance from a healthcare provider.

Risk Factors and Genetic Mutations

Endometrial stromal tumors are known to be caused by genetic mutations and chromosomal aberrations. Certain risk factors may increase the likelihood of developing this type of cancer, including:

• Estrogen therapy
• Tamoxifen therapy
• Polycystic ovary syndrome

Importance of Early Detection

Early detection and treatment of endometrial stromal tumors are critical in improving outcomes. If you experience any symptoms or have a family history of uterine cancer, it's essential to discuss your concerns with a healthcare provider.

References:

• [2] Endometrial stromal sarcoma is a rare form of cancer that occurs due to abnormal and uncontrolled cell growth in the uterus.
• [8] The most common symptom of endometrial stromal sarcoma (ESS) is irregular vaginal bleeding.
• [12] The signs and symptoms of Endometrial Stromal Tumor include unusual vaginal bleeding, abdominal pain, and sensation of pressure in the pelvic area.
• [14] Unusual bleeding from your vagina that's unrelated to menstrual periods or that happens after menopause can be a sign of uterine sarcoma.

Diagnostic Tests for Endometrial Stromal Tumor

Endometrial stromal tumors (ESTs) are a type of cancer that affects the uterus. Diagnosing ESTs can be challenging, but several tests can help identify this condition.

• Light Microscopy: In most instances, ESTs are diagnosed using light microscopy, which examines tissue samples under a microscope [2].
• Endometrial Biopsy and Tissue Sampling: A biopsy of the endometrium (the lining of the uterus) is often performed to collect tissue samples for examination. This test can help identify ESTs and distinguish them from other types of tumors [1, 4].
• Hysteroscopy: Hysteroscopy involves inserting a small camera into the uterus to visually examine the inside of the uterine cavity. This procedure can also be used to collect tissue samples for further examination [1].
• Dilation and Curettage (D&C): A D&C procedure involves dilating the cervix and using a curette to remove tissue from the endometrium. The collected tissue is then examined under a microscope to diagnose ESTs [4, 5].
• Imaging Tests: Imaging tests such as ultrasound and magnetic resonance imaging (MRI) can provide diagnostic clues for ESTs by examining the inside of the uterus and surrounding tissues [8].

It's essential to note that diagnosing ESTs requires a combination of these tests and anatomic pathology consultation. A healthcare professional will likely begin with a physical exam and pelvic ultrasound, followed by more specific tests as needed.

References:

[1] Sep 20, 2022 — Tests to diagnose uterine sarcoma · Endometrial biopsy and tissue sampling · Endometrial biopsy · Hysteroscopy · Dilation and curettage (D & C).

[2] by P Baker · 2007 · Cited by 131 — Endometrial stromal tumours (ESTs) are diagnosed in most instances by light microscopy.

[3] The doctor will likely begin with a physical exam and a pelvic ultrasound, but uterine cancer can only be diagnosed through a biopsy, where a tissue sample is ...

[4] Aug 20, 2020 — Diagnostic testing ... Examination of endometrial cells collected during a dilation and curettage (D&C) procedure ... Endometrial biopsy.

[5] Supporting the diagnosis of endometrial stromal tumors when used in conjunction with an anatomic pathology consultation.

[6] by S Stemme · 2014 · Cited by 30 — Rereview of the biopsy specimens revealed a stromal fragment suspicious for an EST in 16, of which eight had received a benign diagnosis on initial review.

[7] Nov 24, 2023 — Diagnosis · Physical examination – looking at and feeling any lump. · A scan – taking pictures of the inside of the body using scans such as an ...

[8] by G Puliyath · 2012 · Cited by 123 — Endometrial sampling, ultrasound, and magnetic resonance imaging can provide diagnostic clues. Total hysterectomy with bilateral salpingo-oopherectomy is the ...

Treatment Options for Endometrial Stromal Tumors

Endometrial stromal tumors, also known as endometrial stromal sarcomas (ESS), are rare types of cancer that affect the uterus. While surgery is often the primary treatment, drug therapy can also play a crucial role in managing this condition.

Hormone Therapy

• Hormone therapy is primarily used to treat low-grade ESS and is rarely used for other types of uterine sarcomas [2].
• Progestins are the main hormonal therapies for endometrial stromal sarcoma, which can help prevent estrogen production in the body [4].

Chemotherapy

• Chemotherapy regimens such as gemcitabine combined with docetaxel or doxorubicin combined with ifosfamide may be used to treat high-grade ESS (HGESS) [3].
• Doxorubicin-based regimens or gemcitabine in combination with other drugs are commonly used for treating advanced uterine sarcomas, including HGESS [6].

Other Treatment Options

• A combination of docetaxel and gemcitabine may be given as a treatment option for ESS.
• Hormonal therapy, especially high-dose progestins and aromatase inhibitors (AIs), has demonstrated efficacy against these tumors [8].
• Radiation therapy or chemotherapy may also be used after surgery to treat any remaining cancer cells.

References

[1] Context result 1: Women with endometrial stromal sarcomas might get radiation, hormone therapy, or both after surgery. Chemo may be used if other treatments don't work. [2] Context result 2: Hormone therapy is mainly used to treat low-grade ESS and is rarely used for the other types of uterine sarcomas. [3] Context result 3: Commonly used chemotherapy regimens for HGESS includes gemcitabine combined with docetaxel, doxorubicin combined with ifosfamide, doxorubicin... [4] Context result 4: Progestins: These drugs are the main hormonal therapies for endometrial stromal sarcoma. [5] Context result 5: Uterine sarcoma treatment is primarily surgery, with or without radiation or chemotherapy. [6] Context result 6: Patients with advanced uLMS are treated with chemotherapy. In the first-line setting, doxorubicin-based regimens or gemcitabine in combination... [7] Context result 7: A combination of drugs, such as docetaxel and gemcitabine, may be given. [8] Context result 8: Hormonal treatment, especially high-dose progestins and aromatase inhibitors (AIs), has demonstrated efficacy against these tumors.

The differential diagnosis for endometrial stromal tumors involves distinguishing them from other types of uterine tumors, particularly those that may have similar histological features.

According to various studies and medical resources [1][2], the main differential diagnoses for endometrial stromal tumors include:

• Cellular leiomyoma: This type of tumor is characterized by its smooth muscle-like appearance, which can be similar to that of endometrial stromal tumors. However, cellular leiomyomas typically have a more uniform and compact growth pattern [1].
• Low-grade endometrial stromal sarcoma (LG-ESS): LG-ESS is a rare type of uterine cancer that shares some histological features with endometrial stromal tumors. However, LG-ESS tends to have a more infiltrative growth pattern and may exhibit nuclear atypia [2].
• Uterine tumor resembling a sex cord-stromal tumor: This type of tumor can be difficult to distinguish from endometrial stromal tumors, particularly in curettage specimens [3].

To aid in the differential diagnosis, various immunohistochemical markers have been identified. For example, IFITM1, CD10, SMA, and h-caldesmon have been found to be helpful in distinguishing endometrial stromal tumors from cellular leiomyomas [4].

Correct diagnosis of endometrial stromal tumors is critical for proper patient management, as it can impact treatment decisions and prognosis. The current (2020) WHO classification categorizes endometrial stromal tumors into four subtypes: endometrial stromal nodule, low-grade endometrial stromal sarcoma, high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma [5].

References:

[1] Moore M., McCluggage W.G. Uterine endometrial stromal tumors with limited infiltration: First report of a case series indicating potential for malignant behavior ...

[2] Stemme S, Ghaderi M, Carlson JW . Diagnosis of endometrial stromal tumors: a clinicopathologic study of 25 biopsy specimens with identification of problematic areas. Am J Clin Pathol 2014;141:133

[3] A uterine tumor resembling a sex cord-stromal tumor may enter in the differential diagnosis, especially in curettage specimens if the endometrial stromal ...

[4] by P Baker · 2007 · Cited by 131 — When studying a tumour with clear cells, PEComa should always be considered in the differential diagnosis. A panel of antibodies should be used when ...

[5] They are classified into endometrial stromal nodule, low-grade endometrial stromal sarcoma, high-grade endometrial stromal sarcoma, and undifferentiated uterine sarcoma by the current (2020) WHO classification.