Endometrial stromal tumors

Last revised by Angela Liao on 7 Jul 2023

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.

  • endometrial stromal nodule (ESN)

  • low-grade endometrial stromal sarcoma (LGESS)

  • high-grade endometrial stromal sarcoma (HGESS)

  • undifferentiated uterine sarcoma (UUS)

Lesions can be of mixed echotexture 3.

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

  • T2: may show bands of low signal (representing preserved bundles of myometrium) within the areas of myometrial involvement  

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