Endometrial stromal tumors

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Endometrial stromal tumors (EST) are an uncommon group of tumors arising from endometrial stromal cells. It accounts for <2% of all uterine malignancies and 10% of all uterine sarcomas.

Epidemiology

Half occur in premenopausal women, with most patients presenting in the 5th decade.

Clinical presentation

The symptoms are non specific and include menorrhagia, abdominal pain or a palpable pelvic mass.

Pathology

Over the past four decades, EST classification has gone through various modifications starting from the earliest study by Norris and Taylor. This was primarily due to the rarity of the tumors. With better understanding, and at the time of writing (mid 2016), the 2014 WHO classification has replaced the broad categories of the 2003 WHO classification following incorporation of molecular findings.

Radiographic features

Ultrasound

Lesions can be of mixed echotexture .

MRI

Features reported to be more prevalent in EST include :

irregular margin(s)
nodular lesions at the margin(s)
intra-myometrial nodular extension
multiple nodular mass formation
tumor extension along the vessels or ligaments (considered characteristic )

Signal characteristics

T2: may show bands of low signal (representing preserved bundles of myometrium) within the areas of myometrial involvement