Endometrial stromal neoplasia: An uncommon tumor at a tertiary health centre in coastal India

Introduction and Aim: Stromal malignancies of uterus are rare and accounts for 1-3% of all female genital tract malignancies. They are known to pose a diagnostic challenge to the clinicians and the pathologists. They show non-specific clinical features, gross appearance, varying histological and immunohistochemical features. This study highlights the important clinical, morphologic and immunohistochemical features of these tumors. Methodology: Histopathologically diagnosed cases of endometrial stromal neoplasia over a period of 5 years from 2013 to 2017 were retrieved. The cases were analysed based on age, tumor size and histological types. Immunohistochemistry (IHC) was done whenever feasible. Results: During the study period, we found 25 cases of endometrial stromal neoplasia. They were composed of four cases of endometrial stromal nodule (ESN), six cases of low grade endometrial stromal sarcoma (ESS) and three cases of ESS with smooth muscle differentiation. Twelve cases of carcinosarcomas and adenosarcomas and a single case of undifferentiated uterine sarcoma were seen. The mean age at presentation of Mixed epithelial stromal sarcoma (Carcinosarcoma) was 61 years while that of ESS and ESN was 46 and 47 years respectively. The mean size of ESN was 3.6cm (1.5-6cm), ESS was 4.5 cm (2-9.9 cm) and carcinosarcomas was 4.9 cm (2.5-16 cm). Conclusion: Endometrial stromal neoplasia should be diagnosed after proper evaluation of gross morphology, histological features and immunohistochemical findings in correlation with the clinical presentation. In addition, genetic profiling is useful as an ancillary test. The spectrum of endometrial stromal neoplasia is a beginner’s ordeal if not aware of.