Surgical Management of Advanced Endometrial Stromal Sarcoma: A Case Report

Endometrial stromal sarcoma (ESS) is a rare uterine malignancy characterized by nonspecific clinical presentation and aggressive biological behavior, particularly in high-grade forms. Due to its rarity, optimal management remains challenging, with surgery representing the mainstay of treatment. We report the case of a 66-year-old woman with a history of gastrointestinal stromal tumor who was diagnosed with high-grade endometrial stromal sarcoma. The patient initially underwent intestinal reconstruction with termino-terminal anastomosis and bilateral adnexectomy. During subsequent surgery, a large tumor of uterine origin with invasion of the urinary bladder was identified. Complete en bloc resection of the tumor, including regional mesenteric lymph nodes, was achieved. Histopathological examination confirmed high-grade ESS (AJCC TNM 2017: pT1b Nx Mx). The postoperative course was uneventful, and the patient was referred for adjuvant chemotherapy. This case demonstrates that radical en bloc surgical resection is feasible even in advanced high-grade ESS. Comprehensive surgical management remains crucial for achieving optimal disease control, reducing recurrence risk, and improving long-term outcomes.