SCG

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CLINICAL CASE PRESENTATION
Caravaggio, 15-17 Maggio 2008
Ospedale San Raffaele, Milano Serena
Montoli Dr.ssa Mangili G, Rabaiotti E,
Garavaglia E, De Marzi P, Viganò R, Gentile C,
Petrone M, Pella F, Prof. Augusto Ferrari
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SCG

• 45 year old
• Regular menses
• Hypothyroidism
• 1 term delivery
• Appendicectomy

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Presenting Symptoms June 2005

• Admission to Thoracic Surgery Department for
  dyspnoea
• Chest CT bilateral lung nodules suggestive for
  metastases

• Negative abdominal CT scan
• Negative mammography
• Negative bronchoscopy

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(No Transcript)
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• June 2005 Thoracoscopic exeresis of one lung
  nodule

• metastasis of endometrial stromal
• sarcoma (ESS)PgR,Er

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Low-power micrographs demonstrating
histolopathology of pulmonary nodular lesion
surgically removed by thoracoscopic exeresis.
The diagnosis is metastasis of low-grade
endometrial stromal sarcoma. Tumor cells are
fairly uniform, with a storiforme and
peri-vascular arrangement, fusiform in shape,
with minimal nuclear atypia, and scanty
cytoplasm. (haematoxylin and eosin, x 20).
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Megestrol acetate 160 mg daily
SCG

• July 2005 hysterectomy with bilateral
  salpingo-oophorectomy
• ?low grade ESS widely infiltrating
  myometrium (12 on 15 mm)

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SCG

• November 2005 improvement of dyspnoea, stable
  pulmonary lesions and no further
  metastatic spread
• January 2006 Left thoracotomy with exeresis
  of 8 nodules of which 2 where positive
  for LGESS
• March 2006 Right thoracotomy with exeresis
• of 9 nodules of which one positive
• for bronchiolar-alveolar carcinoma G2

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SCG march 2008 NED
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• Key-points
• Surgery is the cornerstone of ESS therapy,
  including bilateral oophorectomy
• Surgical treatment of metastases
• Efficacy of progestins