92 - Postersitzung
17. Mai 2019, 12:30 - 14:00, Bellavista 2, 6. OG
Recurrent endometrial stromal sarcoma mimicking a thrombus in the mesenteric vein: A case report
L.-M. Schupp, R. Galli, C. Kull, R. Rosenberg, Presenter: L.-M. Schupp (Liestal)
A case of a 61-year-old woman with an unexpected presentation of recurrence for low-grade endometrial stromal sarcoma within the mesenteric vein is presented
A 61-year-old woman underwent hysterectomy and rectosigmoid resection for low-grade endometrial stromal sarcoma in 2011. 5 years later a laparotomy with resection of a pelvic recurrence as well as a metastasis at the root of the mesocolon invading the inferior mesenteric vein was performed. A surveillance computed tomography two years later highlighted a round structure in the proximal superior mesenteric vein at the level of the confluence. On sonographic examination, this finding was highly suspicious for a partially floating thrombus and anticoagulation was started. Three months later, a follow up ultrasound showed a slightly progression of the thrombus, so that the initial diagnosis was questioned. A PET-CT revealed a metabolic active mass at the level of the confluence without extravascular extension. After discussion at the tumour board, surgical exploration was performed. After extensive mobilisation of the pancreas and exposure of the confluence, a tumour thrombectomy was performed with en bloc resection of the venous wall including the obliterated proximal inferior mesenteric vein. The confluence was reconstructed using a greater saphenous vein patch. Postoperative course was characterized by a biochemical leak with transient elevated amylase in the surgical drains which settled one week after the surgery. Histopathology confirmed a metastasis of a low-grade endometrial stromal sarcoma. The cells showed a marked positivity for oestrogen (100%) and progesterone (>95%) receptors. Adjuvant hormonal treatment with an aromatase inhibitor was started to prevent further recurrence.
To the best of our knowledge, this is the first report of a case of isolated distant recurrence of low-grade endometrial stroma sarcoma within the mesenteric vein. PET-CT is advised in patients presenting with a suspect thrombus of the mesenteric or portal venous system after treatment for uterine stromal sarcoma since recurrence can mimic classic venous thrombosis.