자궁간질세포육종

초록

Endometrial stromal sarcoma (ESS) is a tumor of endometrial stromal cells that invades the myometrium, accounting only 0.2% of all malignant uterine tumors. Mitotic activity and nuclear atypia are important prognostic features distinguishing high-grade ESS and low-grade ESS, though the histological criteria are controversial. We experienced a case of ESS of 58-year-old female who presented with lower abdominal discomfort and egg-sized palpable left adnexal mass on physical and ultrasonographic examination. Surgical exploration disclosed multinodular masses involving both ovaries that was histologically diagnosed as bilateral metastatic ESS on intraoperative frozen section. Total abdominal hysterectomy with pelvic lymph node dissection was followed consecutively and disclosed a well circumscribed small (1.5×1cm) mass located at the endomyometrial junction of the uterine corpus. Microscopically, the tumor of the uterine corpus showed peculiar low-grade ESS including monotonous appearance of the tumor cells resembling proliferative phase endometrial stromal cells and mitotic figures less than 1 per 10 high power field accompanied by proliferation of small vessels and arterioles resembling endometrial spiral arterioles. The foci of broad bands of tumor cells invading the myometrium were identifed but lymphovascular invasion was not found. Immunohistochemically, the tumor cells were positive for heterogenously postive for CD10 and homogenously expressed estrogen progesterone receptor.