| Objective:To study the clinical features and assess the treatment and prognosis of endometrial stromal sarcoma(ESS).Methods:A retrospective analysis was performed. Clinicopathologic data were retrieved from cases that were confirmed to be ESS in our hospital from January 1995 to December 2007. All pathology sections were reviewed by the pathologic specialist. SPSS 16.0 was used for statistical analysis.Results:1. Clinical profilesESS was confirmed histopathologically in 37 women. Among them, there were 26 patients with low-grade endometrial stromal sarcoma and 11 patients with undifferentiated endometrial sarcoma. The median age at diagnosis was 46 years (range: 28-62 years).29 patients(78.4%) were premenopausal and 8 patients (21.6%) were postmenopausal.The distribution of main symptoms was as follows:menorrhagia was the most common symptom(15/37,40.5%), irregular vaginal bleeding(9/37,24.3%), pain in lower abdomen(6/37,16.2%), asymptomatic patients(7/37,18.9%). The predominant sign was uterus enlarged(19/37,51.4%). Among this,9 patients is bigger than like 10-week pregnancy.2 patients (2/37,5.4%) were found as prolapsing polyp.10 patients were pathologically confirmed before surgery with definite diagnosis rate 37%, (They were diagnosed by D&C or hysteroscopy, of which 6 patients were LESS, and 4 patients were UES). The other 27 patients (73%) were misdiagnosed as uterine leinmyoma or ademomyosis before surgery, of which 13 patients(35.1%) were confirmed during surgery, and 14 patients (37.8%) were confirmed after surgery, respectively.All the patients in the research underwent surgery. According to FIGO staging system (1989), there were 26 LGESS of stage 1,4 of stage II,3 of stage III and le of stageâ…£; 11 UES of stageâ… ,5 of stage II,2 of stage III and 3 of stageâ…£. Among of them,25 patients (67.6%) accepted total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy(BSO),6 patients(16.2%) accepted TAH with unilateral salpingo-oophorectomy (USO),6 patients(16.2%) accepted radical hysterectomy with pelvic lymphadenectomy (one of patients added epiploectomy), but 12 patients(32.4%) accepted secondary enlarged operation (excision of cervical stump/TAH with BSO).24 patients(68.6%) received chemotherapy after surgery(used scheme for VAD,BIP),9 patients (25.7%) received hormone therapy(of which 1 cases received chemotherapy combined with hormone therapy),2 patients (5.7%) received irradiation in other hospital.2. Follow-upOne patient was lost to follow up. Based on 36 patients who had adequate follow up data, the 5 years survival rate was 81%in stage I and II, and 16.7%in stage III andâ…£. The 5 years survival rate of low-grade endometrial stromal sarcoma was 85%, and the 5 years survival rate of undifferentiated endometrial sarcoma was 25%. Twenty patients (55.6%) developed recurrent disease, most of them in the pelvis. The recurrent rate was 83.3%in patient with ovarian preservation versus 31.6%in those without preservation.Conclusion:1. It is difficult to make correct diagnosis before surgery because the clinical manifestation of ESS is atypical. To improve prognosis, we suggest that the patients should undergo diagnostic curettage and biopsy of cervical neoplasm if any suspicion was existed. The frozen section examination is necessary and can increase the diagnostic rate intraoperatively.2. Comprehensive treatment based on surgery can reduce the recurrence rate. The pathologic type, stage and operative patterns were related to prognosis of the disease significantly. |
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