Stromal tumors
Endometrial stromal neoplasms - general

Topic Completed: 1 August 2011

Revised: 15 July 2019

Copyright: 2002-2017, PathologyOutlines.com, Inc.

PubMed search: endometrial [title] stromal tumors uterine

Mohamed Mokhtar Desouki, M.D., Ph.D.
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Cite this page: Desouki M. Endometrial stromal neoplasms - general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusessgeneral.html. Accessed July 20th, 2019.
Definition / general
  • May be benign (stromal nodule with pushing margins) or malignant (infiltrating margins, low or high grade)
  • May contain separate areas of epithelium-like formations in the form of solid masses, glandular structures or cords resembling sex cord structures (also known as uterine tumors resembling sex cord structures, which tend to behave in benign manner)
  • Tumors with smooth muscle and stromal features should be classified and treated as stromal sarcomas (Mod Pathol 2000;13:328)
  • Difficult to diagnose as nodule vs. sarcoma based on curettings because invasion cannot be assessed; but consider tumor of some kind if endometrial stroma is present without glands
  • Includes endometrial stromal nodule, low grade, endometrial stromal sarcoma, undifferentiated endometrial sarcoma
  • Average age 45 years, present with vaginal bleeding
Prognostic factors
  • Endometrial stromal sarcomas are indolent tumors with a favorable prognosis
  • Tumors are characterized by late recurrences commonly in the pelvis and abdomen, and less frequently in the lung and vagina
  • Surgical stage is the most important prognostic parameter
  • Hysterectomy and bilateral salpingo-oophorectomy
Gross description
  • Soft, yellowish orange
Microscopic (histologic) description
  • Haphazard arrangement (not fascicular) of uniform small cells resembling endometrial stroma (blunt, spindled to oval with scant cytoplasm and small, uniform nuclei), individually enveloped by reticulin fibers
  • Stromal cells circle small / thin vessels that resemble spiral arterioles; also hyalinization and foamy cells
  • May have prominent vasculature resembling hemangiopericytoma
Positive stains
Molecular / cytogenetics description
  • Endometrial stromal sarcomas often carry the translocation t(7;17) with involvement of two zinc finger genes: JAZF1 and JJAZ1
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