SESSION TITLE: Malignant Disease Global Case Reports
SESSION TYPE: Global Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Endobronchial metastasis from endometrial stromal sarcoma is an extremely rare case. Here, we describe a case of a 43-year-old woman who presented with cough and gradually aggravating exertional dyspnea, and was subsequently diagnosed with an endobronchial metastasis from endometrial stromal sarcoma. She was treated with interventional therapy through bronchoscopy, transcatheter arterial chemoembolization and radiotherapy. At her 1-year follow-up she was asymptomatic.
CASE PRESENTATION: A 43-year-old woman presented with cough and gradually aggravating exertional dyspnea of 5-months’ duration. She had undergone a hysteromyomectomy for myoma uteri 3 years previously. Computed tomography scan of the chest revealed a soft tissue mass completely obstructing the right main bronchus, and a solitary round nodule, 3.6 cm × 2.6 cm in size, in the medial basal segment of right lower lobe, with a regular margin and heterogenous enhancement . Bronchoscopy demonstrated total occlusion of the right mainstem bronchus by a smooth and polypoid tumor. Histologic sections of biopsy from the endobronchial tumor revealed uniform and dense proliferation of spindle tumor cells with round to oval nuclei. Immunohistochemistry showed that the tumor cells were negative for smooth muscle actin and positive for vimentin and CD10. The patient was diagnosed as endobronchial metastasis from endometrial stromal sarcoma (ESS). Because she had a history of hysteromyomectomy, transvaginal ultrasonography was done and revealed the uterus 11.1 cm x 7.9 cm x 7.8 cm in size with two heterogeneous echogenic masses, 9.4 cm x 4.4 cm and 4.5 cm x 3.6 cm in size, respectively. The endobronchial mass was resected through snare of high-frequency electrocautery and cryotherapy during flexible bronchoscopy with resolution of the obstruction. After the interventional therapy, the right mainstem bronchus, the right middle lobe bronchus and the right lower lobe bronchus were all patent, with only a small stalk of the mass remaining in the bronchus segmentalis basalis medialis of right lower lobe, which suggested the endobronchial tumor originated from this bronchus. Therefore, the patient’s cough and dyspnea disappeared. Subsequently, digital subtraction angiography and transcatheter arterial chemoembolization of bilateral uterine artery was performed, and the infusional chemotherapeutics were carboplatin 200mg and epirubicin 40mg. After one month of uterine chemoembolization, digital subtraction angiography and transcatheter arterial infusion of the right bronchial artery was done. After 4 months of the interventional therapy, the patient underwent conformal intensity-modulated radiotherapy and the total dose for lesions in the uterus field was 6, 000 cGy. After 7 months of the interventional therapy, the patient underwent conformal intensity-modulated radiotherapy again and the total dose for the mass in the lung field was also 6, 000 cGy. The patient was well and showed no apparent symptom when last seen, 12 months post the interventional therapy. Repeat computed tomography of the chest showed the size of the lesion in the medial basal segment of right lower lobe was decreased, 2.4 cm × 1.6 cm in size, and there was no new pulmonary nodule suggestive of metastasis.
DISCUSSION: To the best of our knowledge, no previous reports have described of endobronchial metastasis from ESS. Our patient is the first case of endobronchial metastasis from ESS. Consequently, our case reminds physicians to consider the possibility of endobronchial metastasis from uterine sarcoma. Because of the rarity of this tumor, data from largescale trials are not available to guide standardized systemic therapy . Currently, therapy for ESS includes surgical resection for localized lesion, debulking surgery for metastatic lesion, radiotherapy, chemotherapy and hormone therapy. The survival for patients with ESS with pulmonary metastases is not clear. In our patient, the tumor has been a relatively slow process, and she remains almost asymptomatic after the interventional therapy, transcatheter arterial chemoembolization and radiotherapy for endobronchial and pulmonary metastases from uterus.
CONCLUSIONS: Our patient is the first case of endobronchial metastasis from ESS. Consequently, our case reminds physicians to consider the possibility of endobronchial metastasis from uterine sarcoma.
Reference #1: Rauh-Hain JA, del Carmen MG. Endometrial Stromal Sarcoma: A Systematic Review. Obstet Gynecol 2013;122:676-83.
DISCLOSURE: The following authors have nothing to disclose: Xu-Wei Wu, Yan-Hong Liu, Yi Xiao, Zhi-Dong Li, Xi-Qian Xing
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