Endometrial stromal sarcoma in a large fibroid uterus presenting with sepsis-like picture, extensive pelvic thrombosis and severe menorrhagia

Abstract

This case report aims to demonstrate the diagnostic challenges of uterine sarcomas, presenting with presumed benign symptoms. Missed clinical clues and consequently a delayed diagnosis demonstrates the importance of considering uterine sarcomas as a differential, particularly in premenopausal women. This case report describes the case of a woman in her early 40s, who presented with symptoms of fibroids, before receiving an incidental diagnosis of endometrial stromal sarcoma, almost a year after her initial hospital presentation. The patient had an extensive investigative period, repeatedly returning to hospital with symptoms including lower abdominal pain and heavy vaginal bleeding, and imaging and biopsies not pointing clinicians to the diagnosis. Many findings and reports presented clues which should have pointed towards an alternative diagnosis-raised LDH, extensive pelvic thrombosis, the presence of a pelvic lymph node, and lack of response to treatment-none of which were considered as consequences of a uterine sarcoma. Diagnostic interpretation was complicated by factors such as a raised BMI, continuous bleeding, and the need for anticoagulation, making the final diagnosis hard to reach. This case demonstrates the criticalness of considering uterine sarcomas as a mimic for benign gynaecological conditions and symptoms. Timely recognition and early consideration is critical to improve outcomes, and uterine sarcomas should always be discussed as a potential diagnosis, especially in premenopausal women.