The Clinical and Histologic Spectrum of Endometrial Stromal Neoplasms

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Abstract
Clinical and pathological features of 41 homologous uterine stromal tumors classified by the criteria of Norris and Taylor were reviewed. These included stromal nodules (12 cases), endolymphatic stromal myosis (20 cases), and stromal sarcoma (9 cases). Patients ranged in age from 18 to 79 with a median of 45 yr. Symptoms were similar in all 3 forms and included vaginal bleeding (63%), pelvic pain (11%), or an abdominal mass (6%), while 26% of patients were asymptomatic. Tumors characteristically resembled endometrial stroma histologically, but variations included hemangiopericytoma and "sex-cord-like" patterns, hyalinization, and foam cells. A sex-cord-like pattern was seen only with stromal nodules and endolymphatic stromal myosis. Necrosis was seen in all 3 lesions, whereas nuclear anaplasia was seen only with stromal sarcoma. Follow-up ranging from 2 mo. to 12 yr (median interval: 5 yr) was obtained in 23 cases. No recurrences were recorded among 6 stromal nodules. Endolymphatic stromal myosis behaved as an indolent low grade malignancy, with 3 recurrences but no deaths among 13 patients; these occurrred at 3-7 yr after initial diagnosis. Stromal sarcoma behaved as a high grade malignancy, with 2 deaths among 5 patients with follow-up, both occurring within 8 mo. of diagnosis.