Analysis Of Endometrial Stromal Sarcoma-33 Cases Report

Endometrial stromal sarcoma (ESS) is a rare uterine malignant tumors(uterine sarcoma) from endometrial stroma cells,accounting for 0.28%～0.84% of all uterine malignancies and 7%～l5% of all uterine sarcomas. Its frequent symptoms have irreguler vaginal bleeding,pelvic mass and pain,dysmenorrhea,and so on. Owing to no specific clinical signs, endometrial stromal sarcoma has often been misdiagnosed before operation, Final diagnosis mainly depended on pathological results.Thus most of cases can not be diagosed before operation.Due to the low incidence rate, endometrial stromal sarcoma lacks of large-scale cases clinical studies.At present,to its diagnosis and the treatment at exploration stage, there are still not ideal diagnosis standard and treatment methods.Objectives:To analyze clinical features of ESS,discuss its diagnosis , therpy and prognosis of the disease,provide empireical basis for therpy.To improve the rate of preoperative diagnosis, find ideal treatment metheds, prolong patients'survival stage.Metheds:Data were collected from 33 patients with ESS treated during the period of Jan.1992 to Oct.2006 in Shanxi Province Tumor Hospital . Their clinical characteristics , diagnosis,treatment and prognosis were analyzed.Statistical analysis was performed using SPSS 13.0 software, and Chi-square test Kaplan-Meiermethed and log-rank test were adopted.Results:The mean age of the patients was 44.1 years old(range 18～76)among 33 patients.The symptom of irregular vaginal bleeding were presented in 11 patients,18 patients had been diagnosed to have leiomyoma before treatment;24 patients were diagnosed as low-grade ESS and 9 patients as high-grade ESS. All cases were diagnosed by postoperative pathological results. Operation was the main treatment,combined with chemotherapy and radiotherapy.The median follow-up time was 46 months, the overall 3-year,5-year and 10-year survival rates were 73.3%, 56%and 20%,respectively. The 5 years survival rate was 81.8% in stage I～II.And 25% in stageⅢ～1V.The 3 and 5 year survival of low-grade ESS was 85.7% and 75.0% respectively.and the 3 and 5 years survival rates of high-grade ESS was 44.4% and 22.2%. The survival rate of patients who received adjuvant therapy was reserved versus those without adjuvant therapy. Fifteen patients (45.5%) develped recurrent disease, most of which in the pelvis.The recuurent rate for patients whose ovarian function was the same versus those without reservation. Conclusions:Preoperative diagnosis rate is low.Diagnosis curettage,cervcal os new growths or hysteroscopic biopsy can reduce misdiagnosis rate.Frozen section examination during the operation can increase the diagnostic rate intraoperatively.Diagnosis was mainly confirmed by pathologic results.Low-grade ESS has a good prognoses.Postoperative adjuvant therapy can reduce recurrent and increase survival rate.The prognosis of endometrial stromal sarcoma is closely related to clinical stage,histologic type and treatment...