38 Clinical Cases Report Of Endometrial Stromal Sarcoma

Objective:To analyze the clinical characteristics, ultrasonic manifestations, results of diagnostic curettage, diagnosis rates, treatments, recurrence and factors affecting the prognosis of endometrial stromal sarcoma.Methods:This paper collected 38 cases of ESS patients treated in qilu hospital of shandong university from January 2000 to December 2013, the clinical and follow-up data were retrospectively analyzed. SPSS 20.0 statistical software was used to analyze all the data. Count data was compared by X2 test; Measurement data was compared by t test; The Kaplan Meier survival curve method was used to analyze the single factors affecting the prognosis; Use the COX proportional hazards model to analyze the multiple factors. P< 0.05 was the standard of statistical significance.Results:1. Clinical characteristics1.1 Age and menstrual statusThe youngest patient of these 38 patients is 19 years old and the oldest is 75, with the average age of 42.11 and the median age of 40.5. Among them 30 patients were premenopausal and 8 patients were postmenopausal.1.2 Pregnancy and abortion historyAmong the 38 cases collected in this paper,34 cases have a history of pregnancy and 21 cases have a history of abortion. Patients with LGESS or HGESS have no obvious differences in the history of pregnancy and abortion.1.3 clinical manifestationsThe first symptoms of these 38 cases were mainly menstrual abnormalities or abnormal vaginal bleeding (20 cases,52.6%), abdominal pain (7 cases,18.42%), vaginal drainage (3 cases,7.89%), pelvic mass (2 cases,5.26%) and abdominal distension (1 case,2.63%). The other 5 cases (13.16%) had no symptoms; they discovered the disease by physical examination.2. Ultrasonic manifestationsThe ultrasound examination of the 23 cases collected mainly manifested as heterogeneous echoes (11 cases,47.83%), low echo (7 cases,30.43%), medial-low echo (2 cases,8.70%), medial-strong echo (2 cases,8.70%), strong echo (1 case, 4.35%). In addition,15 patients of the 23 patients could detect a blood flow signal during their ultrasound examination, accounting for 65.22%.3. Diagnostic curettage5 patients of the 38 cases accepted diagnostic curettage before operation due to abnormal vaginal bleeding, and 3 cases of the 5 patients were diagnosed with ESS. The diagnosis rate of diagnostic curettage is 60%.4. The diagnosis rate4.1 Preoperative diagnosis rateAmong these 38 patients,5 patients were diagnosed with ESS before operation; the preoperative diagnosis rate was 13.16%.4.2 Intraoperative diagnosis rate17 patients of the 38 cases accepted fast frozen pathologic examination during operation, and 14 cases of the 17 patients were diagnosed with ESS. The intraoperative diagnosis rate is 82.35%.4.3 Postoperative diagnosis rateIn addition to the above 5 cases diagnosed preoperatively and 14 cases diagnosed intraoperatively, the remaining 19 cases were all diagnosed with ESS after operation by routine pathology. The postoperative diagnosis rate was 100%.5.TreatmentAll these 38 patients accepted operation in our hospital, among which 26 cases accepted adjuvant therapy after operation (including 12 cases accepting chemotherapy, 9 cases accepting endocrine therapy,1 case accepting radiotherapy,1 case accepting chemotherapy plus radiotherapy,1 case accepting chemotherapy plus endocrine therapy). The result showed that postoperative adjuvant treatment did not obviously increase the overall survival (P=0.507).6.RecurrenceAmong the 33 cases followed up in this paper 7 cases relapsed after their operations, making the recurrence rate up to 21.21%. The average recurrence time is 48 months. The most common places for recurrence are pelvic and abdominal cavity, while the second is the lungs.7. Survival rate and analysis of prognostic factors7.1 The overall survival rateThe 1,2,5-year overall survival rates of 33 cases were 100%,89.29% and 73.33% respectively.7.2 Analysis of single factor affecting the prognosisHistological type, clinical stage and lymph node metastasis are the single factors affecting the prognosis of patients with ESS.Patients with HGESS and that with lymph node metastasis have a worse prognosis; The later the stage, the worse the prognosis.7.3 Analysis of multiple factors affecting the prognosisHistological type is the independent factor affecting the prognosis of patients with ESS.Conclusion:The most common sonographic finding of ESS is heterogeneous echoes and abundant blood flow signals. Diagnostic curettage and rapid pathologic examination have important value in the preoperative diagnosis of endometrial stromal sarcoma. The first treatment for endometrial stromal sarcoma is total hysterectomy plus bilateral adnexectomy. Neither expanding the operation range nor postoperative adjuvant therapy can improve the surial rates of ESS patients. Clinical stage, pathological grading and lymph node metastasis are the single factors affecting the prognosis of patients with ESS. Pathological grading is the independent factor affecting the prognosis of patients with ESS.