CASE REPORT article
Front. Oncol.
Sec. Gynecological Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1641836
This article is part of the Research TopicCutting-Edge Strategies in Screening, Prevention, and Treatment in Gynaecologic OncologyView all 27 articles
Pelvic Venous and Pulmonary Artery Extension in Low-Grade Endometrial Stromal Sarcoma: A Case Report
Provisionally accepted
- Third Xiangya Hospital, Central South University, Changsha, China
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Background: Vascular invasion is a hallmark of low-grade endometrial stromal sarcoma (LG-ESS), typically presenting a tumor thrombus within the parametrial vessels. However, extension of tumor thrombus into major vessels such as pulmonary artery is extremely rare. This case report presents an unusual manifestation of LG-ESS with intravascular tumor thrombi extending to the pelvic venous and pulmonary artery, highlighting the diagnostic challenges and clinical implications of vascular involvement. Case presentation: A 42-year-old female presented with prolonged menstruation. Imaging examination initially suggested multiple uterine fibroids, and hysteroscopic resection of a polypoid lesion revealed stromal hyperplasia, raising suspicion of an endometrial stromal nodule. One year later, the patient developed a pulmonary embolism and imaging showed disease progression. A hysteroscopic biopsy confirmed the diagnosis of LG-ESS. She subsequently underwent total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) and venous thrombectomy. Histopathological examination revealed LG-ESS with deep myometrial invasion and extensive intravascular tumor thrombus extending into the pelvic veins. The pathological stage was pIIA(FIGO). Postoperative chemotherapy with liposomal doxorubicin was administered, and follow-up pulmonary computed tomography angiography showed resolution of the emboli. No recurrence was noted at the six-month follow-up. Conclusions: This case highlights the diagnostic complexity of LG-ESS due to its nonspecific clinical presentation and imaging findings, especially in early stages. Rare vascular involvement, including pulmonary artery tumor embolism, poses a risk of misdiagnosis and highlights the importance of thorough histopathological evaluation. Early hysteroscopic intervention, accurate pathological assessment, and individualized adjuvant therapy are critical for optimizing outcomes in patients with LG-ESS exhibiting vascular extension. Informed consent for publication was obtained from the patient.
Keywords: Low-grade endometrial stromal sarcoma, Vascular invasion, Tumor thrombus, Pulmonary Embolism, Uterine sarcoma
Received: 05 Jun 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Li, Sun, Ye, Wang, Cheng, Huang and Xi. 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: Xin Sun, Third Xiangya Hospital, Central South University, Changsha, China
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