Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Liao A, Yap J, et al. Endometrial stromal tumors. Reference article, Radiopaedia.org (Accessed on 23 Apr 2024) https://doi.org/10.53347/rID-13053
Endometrial stromal tumors (EST) are an uncommon group of tumors arising from endometrial stromal cells. They account for <2% of all uterine malignancies and 10% of all uterine sarcomas 7.
Half occur in premenopausal women, with most patients presenting in the 5th decade.
The symptoms are non-specific and include menorrhagia, abdominal pain or a palpable pelvic mass.
Over the past four decades, the classification of endometrial stromal tumors has gone through various modifications starting from the earliest study by Norris and Taylor 6. This was primarily due to the rarity of the tumors. The 2020 WHO classification has since replaced the broad categories of the 2003 WHO classification following the incorporation of molecular findings.
Classification
endometrial stromal nodule (ESN)
low-grade endometrial stromal sarcoma (LGESS)
high-grade endometrial stromal sarcoma (HGESS)
undifferentiated uterine sarcoma (UUS)
Ultrasound
Lesions can be of mixed echotexture 3.
MRI
Features reported to be more prevalent in endometrial stromal tumors include 1:
irregular margin(s)
nodular lesions at the margin(s)
intra-myometrial nodular extension
multiple nodular mass formation
tumor extension along the vessels or ligaments (considered characteristic 5)
Signal characteristics
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1. Ueda M, Otsuka M, Hatakenaka M et-al. MR imaging findings of uterine endometrial stromal sarcoma: differentiation from endometrial carcinoma. Eur Radiol. 2001;11 (1): 28-33. Eur Radiol (link) - Pubmed citation
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2. Furukawa R, Akahane M, Yamada H et-al. Endometrial stromal sarcoma located in the myometrium with a low-intensity rim on T2-weighted images: report of three cases and literature review. J Magn Reson Imaging. 2010;31 (4): 975-9. doi:10.1002/jmri.22126 - Pubmed citation
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3. Gandolfo N, Gandolfo NG, Serafini G et-al. Endometrial stromal sarcoma of the uterus: MR and US findings. Eur Radiol. 2000;10 (5): 776-9. Eur Radiol (link) - Pubmed citation
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4. Rha SE, Byun JY, Jung SE et-al. CT and MRI of uterine sarcomas and their mimickers. AJR Am J Roentgenol. 2003;181 (5): 1369-74. AJR Am J Roentgenol (full text) - Pubmed citation
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5. Koyama T, Togashi K, Konishi I et-al. MR imaging of endometrial stromal sarcoma: correlation with pathologic findings. AJR Am J Roentgenol. 1999;173 (3): 767-72. AJR Am J Roentgenol (abstract) - Pubmed citation
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6. Norris, Henry J., and Herbert B. Taylor. "Mesenchymal tumors of the uterus. I. A clinical and pathological study of 53 endometrial stromal tumors." Cancer 19.6 (1966): 755-766. Pubmed citation
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7. Kaku, Tsunehisa, et al. "Adenosarcoma of the uterus: a Gynecologic Oncology Group clinicopathologic study of 31 cases." International journal of gynecological pathology 11.2 (1992): 75-88. Pubmed citation
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8. Ali, Rola H., and Marjan Rouzbahman. "Endometrial stromal tumours revisited: an update based on the 2014 WHO classification." Journal of clinical pathology (2015): jclinpath-2014. Pubmed citation
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