CASE REPORT article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1676847
This article is part of the Research TopicCutting-Edge Strategies in Screening, Prevention, and Treatment in Gynaecologic OncologyView all 18 articles
Multimodal imaging features of high-grade endometrial stromal sarcoma with pulmonary and nodal metastases: A case report and literature review
Provisionally accepted
- Weifang People's Hospital, Weifang, China
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Background: High-grade endometrial stromal sarcoma (ESS) is an aggressive tumor, presenting diagnostic challenges, particularly when associated with multifocal metastases. Multimodal imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), plays a critical role in diagnosis. Case presentation: A 51-year-old woman presented with abnormal vaginal bleeding and pelvic pain. Ultrasound revealed an 8×12×17 cm heterogeneous mass located in the uterine body and cervix, CT showed metastatic pelvic lymphadenopathy and lung nodules, and MRI demonstrated a T2-hyperintense lesion with myometrial and cervical invasion, along with restricted diffusion on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping. Pathological analysis confirmed high-grade ESS. Results: Multimodal imaging successfully differentiated high-grade ESS from benign lesions by identifying aggressive features such as ill-defined margins (ultrasound), necrosis (CT), and restricted diffusion (MRI).The patient was diagnosed with high-grade ESS stage IVB (T3bN1M1) due to pelvic lymph node involvement and multiple pulmonary metastases. Conclusion: High-grade ESS is prone to distant metastasis. MRI with DWI and ADC mapping is crucial for assessing tumor cellularity and local invasion, while CT effectively detects metastases. Future staging should integrate contrast-enhanced MRI and positron emission tomography-computed tomography (PET-CT).
Keywords: image acquisition, analysis, interpretation, Drafting, and reviewing the final manuscript. T Z:Interpretation, and reviewing the final manuscript H T and T Z: Drafting and reviewing the manuscript endometrial stromal sarcoma, Multimodal Imaging, Neoplasm Metastasis
Received: 31 Jul 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Tan and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tingting Zhang, Weifang People's Hospital, Weifang, China
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