Low-grade endometrial stromal sarcoma with intravenous thrombus extension: a multidisciplinary surgical challenge

Alberto Rafael Guijarro-Campillo; Blanca Segarra Vidal; Víctor Lago; Pablo Padilla-Iserte; Josselyn Andrea Hernández Chinchilla; Iván Martín-González; Santiago Domingo del Pozo

doi:https://doi.org/10.3802/jgo.2023.34.e21

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자료유형: 학술저널

저자정보: Alberto Rafael Guijarro-Campillo (La Fe University and Polytechnic Hospital Valencia Spain) Blanca Segarra Vidal (La Fe University and Polytechnic Hospital Valencia Spain) Víctor Lago (La Fe University and Polytechnic Hospital Valencia Spain) Pablo Padilla-Iserte (La Fe University and Polytechnic Hospital Valencia Spain) Josselyn Andrea Hernández Chinchilla (La Fe University and Polytechnic Hospital Valencia Spain) Iván Martín-González (La Fe University and Polytechnic Hospital Valencia Spain) Santiago Domingo del Pozo (La Fe University and Polytechnic Hospital Valencia Spain)

저널정보: 대한부인종양학회 Journal of Gynecologic Oncology Journal of Gynecologic Oncology Vol.34 No.2

발행연도: 2023.3

수록면: 1 - 2 (2page)

DOI: https://doi.org/10.3802/jgo.2023.34.e21

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Low-grade endometrial stromal sarcoma (LG-ESS) usually exhibits indolent behavior, oftenmisdiagnosed and is associated with a favorable prognosis [1]. Despite the indolent nature ofLG-ESS, recurrence is common, the risk is as high as 1 in 3 to 1 in 2 [2]. The behavior of suchtumors can lead to invade blood vessels [3]. An intravascular tumor is associated with directrisk of sudden death from pulmonar y embolism. There are ver y few reported cases withclinically obvious intravascular extension. Chemotherapy, radiotherapy and hormone therapyare adjuvant treatments that have not been able to demonstrate a definitive benefit in sur vival[4]. We want to take advantage of the opportunity, so far unpublished, to demonstratewith this case the surgical challenge described step by step, as well as to demonstrate theimportance of surger y as the only curative treatment even in extended intravascular disease[5]. Here in, we present the surgical challenge of a LG-ESS in a 59-year old woman with iliacand cava vein tumoral thrombus extension. We performed a tumoral thrombectomy andvascular repair, with a pelvic exenteration and double barrel wet colostomy. After performingpelvic exenteration, the thrombus with intravascular involvement was addressed at 2 points:inferior cava vein and right common iliac vein with the extraction of the entire thrombus. These defects are corrected by angioplasty and venorrhaphy, respectively. The surger y got acomplete cytoreduction. It lasted 290 minutes, with 430 mL blood loss. In patients with LG-ESS, cytoreduction is a reliable option even in extended metastatic disease.

#Keywords: Low-Grade Endometrial Stromal Sarcoma #Tumor Board #Thrombectomy #Total Pelvic Exenteration #Double Barrel Wet Colostomy

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