Hemorrhagic Brain Metastasis of Endometrial Stromal Sarcoma

Salih Gulsen; Aysen Terzi; Ozlem Isiksacan Ozen; Ali Ayhan

doi:10.3889/oamjms.2014.052

Authors

Salih Gulsen Baskent University Medical Faculty Hospital - Neurosurgery, Maresal Fevzi Cakmak cad.10. sok. No: 45, Ankara 06540
Aysen Terzi Baskent University Medical Faculty - Pathology, Ankara
Ozlem Isiksacan Ozen Baskent University Medical Faculty - Pathology, Ankara
Ali Ayhan Baskent University Medical Faculty - Obstetrics and Gynecology, Ankara

DOI:

https://doi.org/10.3889/oamjms.2014.052

Keywords:

stromal sarcoma, endometrium, cranium, metastasis, hemorrhage.

Abstract

High-grade endometrial stromal sarcoma is a rare uterine malignancy. The cells of these tumors resemble endometrial cells in the proliferation stage, with many small plexiform arterioles. Herein we present a patient with endometrial stromal sarcoma that metastasized to the brain, along with the CT and MRI findings and a discussion of the surgical and histopathological features of the metastatic tumor. Immunohistopathological examination of the metastatic tumor showed a high mitotic rate and strong immunopositivity for CD10 and vimentin (as a mesenchymal marker); therefore, the lesion was considered to be high-grade endometrial stromal sarcoma. Due to the rarity of reported cases of metastatic brain tumors of high-grade endometrial stromal sarcoma, there isnâ€™t a standard treatment protocol; however, metastatic tumors of high-grade endometrial stromal sarcoma match the same general concepts of brain metastasis. In addition, endometrial stromal sarcomas may be associated with hemorrhagic metastasis to the brain due to their pathologic characteristics.

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References

American Cancer Society. Cancer Facts and Figures 2009. Atlanta: American Cancer Society; 2009. Available from: http://www.cancer.org/ downloads/STT/500809web.pdf.

Madison T, Schottenfeld D, Baker V. Cancer of the corpus uteri in white and black women in Michigan, 1985-1994: an analysis of trends in incidence and mortality and their relation to histologic subtype and stage. Cancer. 1998;83:1546-54. DOI: https://doi.org/10.1002/(SICI)1097-0142(19981015)83:8<1546::AID-CNCR9>3.0.CO;2-M

Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1960 patients in the RTOG database. International Journal of Radiation Oncology Biology Physics. 2008; 70: 510â€“ 4. DOI: https://doi.org/10.1016/j.ijrobp.2007.06.074

Tosoni A., Ermani M., Brandes A., The pathogenesis and treatment of brain metastases: a comprehensive review. Critical Reviews in Oncology/Hematology. 2004; 52: 199â€“215. DOI: https://doi.org/10.1016/j.critrevonc.2004.08.006

Acharya S, Hensley ML, Montag AC, Flaming GF. Rare uterine cancers. Lancet Oncol. 2005; 6:961-71. DOI: https://doi.org/10.1016/S1470-2045(05)70463-0

Chan JK, Kawar NM, Shin JY, Osann K, Chen LM, Powell CB, et al. Endometrial stromal sarcoma: a population-based analysis. Br J Cancer. 2008; 99:1210-8. DOI: https://doi.org/10.1038/sj.bjc.6604527

Haberal A, KayÄ±kcÄ±oglu F, Boran N, CalÄ±skan E, Ozgul N, Kose MF. Endometrial stromal sarcoma of the uterus: analysis of 25 patients. Eur J Obstet Gynecol Reprod Biol. 2003;109(2):209-13. DOI: https://doi.org/10.1016/S0301-2115(03)00078-2

Inayama Y, Shoji A, Odagiri S, Hirahara F, Ito T, Kawano N, et al. Detection of pulmonary metastasis of low-grade endometrial stromal sarcoma 25 years after hysterectomy. Pathol Res Pract. 2000;196:129-34. DOI: https://doi.org/10.1016/S0344-0338(00)80045-X

Amant F, Moerman P, Vergote I. The classification of a uterine sarcoma as â€˜High-grade endometrial stromal sarcomaâ€™ should be abandoned. Gynecol Oncol. 2004; 95:412-3. DOI: https://doi.org/10.1016/j.ygyno.2004.07.021

Thomas MB, Keeney GL, Podratz KC, Dowdy SC. Endometrial stromal sarcoma: treatment and patterns of recurrence. Int J Gynecol Cancer. 2009; 19:253-6. DOI: https://doi.org/10.1111/IGC.0b013e3181999c5f

Nordal RR, Kristensen GB, Kaern J, et al. The prognostic significance of surgery, tumor size, malignancy grade, menopausal status, and DNA ploidy in endometrial stromal sarcoma. Gynecol Oncol. 1996;62:254-9. DOI: https://doi.org/10.1006/gyno.1996.0224

Blecharz P, UrbaÅ„ski K, Mucha-MaÅ‚ecka A, MaÅ‚ecki K, Reinfuss M, Jakubowicz J, Skotnicki P. Hematogenous metastases in patients with Stage I or II endometrial carcinoma. Strahlenther Onkol. 2011;187(12):806-11,2011. DOI: https://doi.org/10.1007/s00066-011-2250-6

Ogawa K, Yoshii Y, Aoki Y et al. Treatment and prognosis of brain metastases from gynecological cancers. Neurologia Medico-Chirurgica. 2008; 48: 57â€“62. DOI: https://doi.org/10.2176/nmc.48.57

Huang MI, Debernardo RL, Rodgers M, Hart DJ. Endometrial stromal sarcoma metastasis to the lumbar spine and sphenoid bone. Rare Tumors. 2011;3(3):e27. DOI: https://doi.org/10.4081/rt.2011.e27

Akhavan A, Shishebor F, Moghimi M, Binesh F. Endometrial stromal sarcoma of uterus with metastasis to the lung and brain. BMJ Case Rep. 2012;2012. DOI: https://doi.org/10.1136/bcr-2012-006954

Merinsky A, Schmidt M, Heidner K, Koelbl H. Cerebral metastases of an endometrial stromal sarcoma: report of the first case. Onkologie. 2012; 35(5):272-4. DOI: https://doi.org/10.1159/000338520

Stofko DL. Undifferentiated uterine sarcoma metastatic to the brain. Surg Neurol Int. 2013;27:4-12. DOI: https://doi.org/10.4103/2152-7806.119054

Bhargava R, Shia J, Hummer AJ, Thaler HT, Tornos C, Soslow RA. Distinction of endometrial stromal sarcomas from 'hemangiopericytomatous' tumors using a panel of immunohistochemical stains. Mod Pathol. 2005;18:40-7. DOI: https://doi.org/10.1038/modpathol.3800248