Uterine endometrial stromal sarcoma revealed after treatment of uterine fibroid with ulipristal acetate: a case report

Background: High-grade endometrial stromal sarcomas (ESS) are very rare uterine tumors which grow from endometrial stroma and include less than 2% of uterine malignant tumors. Preoperatively it is often difficult to diagnose these tumors due to its image of benign tumors. The authors present a first in the literature, case of a 47-year-old patient with high-grade ESS diagnosed in histopathological examination after treatment with ulipristal acetate. Case Report: Patient was operated with recognition of leiomyoma and was after three months treatment of uterine fibroid with ulipristal acetate. The histopathological examination revealed a high grade ESS and endometrium had the features of hyperplasia without atypia. One month after fast operation, patient was reoperated to expand surgery according to oncologic protocol and remove cervix, adnexa, pelvic and pars-aortic lymph nodes, and explore pelvic and abdominal cavity. All these organs were without neoplastic features. Patient was qualified to postoperative radiation and chemotherapy. Conclusions: In ESS hormone receptors are usually positive and activity of progesterone receptor modulators can influence on course of disease. This case report suggests that the patients qualification for treatment should be preceded by careful and precise clinical examination with precise ultrasound assessment of myoma, flow in uterine arteries, and pattern of flow inside fibroid tumor.