PMC7327825_01
Polypoid Endometriosis, histopathologic sample.
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Histopathological analysis revealed extensive PE (Fig. 1) with foci of simple and complex hyperplasia involving the surface of the uterus, ovaries, fallopian tubes, omentum and the mesentery of ileum, caecum and transverse colon.
MRI abdomen and pelvis in July 2019 showing the large solid-cystic pelvic tumour (13,9 x 10,9 x 21,9 cm). The tumour occupied most of the pelvis: caudally from the ano-rectal junction with components extending to the left greater sciatic notch and intimately related to the left sciatic nerve, whereas cranially reaching up to the level of L4/L5, and hereby displacing the surrounding anatomy. It bordered around the following structures: anterior abdominal wall musculature, multiple loops of large- and small bowel, left iliacus muscle, common iliac vessels bilaterally, left external iliac vessels, left pelvic side wall fascia, presacral fascia, displaced urinary bladder, vaginal vault, left piriformis muscle, left sacro-spinous and sacro-tuberous ligaments and at least the left levator sling.
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Her symptoms of abdominal suprapubic discomfort and lower back pain recurred in June 2019, and MRI demonstrated regrowth of a soft tissue mass in the left pelvic side wall from 2.3 cm maximum diameter to 13.9 x 10.9 x 21.9 cm (Fig. 2).
Specimen removed during the Total Pelvic Exenteration. On the right: upper face of the pelvic mass. On the left: lower face of the pelvic mass; it can be noted the rectum (blue arrow), the superior dome of the vagina after previous total histerectomy (white loop) and the bladder (yellow loop).
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An en bloc removal of the specimen was achieved (Fig. 3), which included the rectal stump, sigmoid, descending colon, top of vagina, bladder, distal ureters bilaterally, left pelvic side-wall with its fascia, left internal iliac artery, left pelvic wall fascia, part of obturator internus muscle, part of the left piriformis muscle and the top of the anal canal.
myxoid low grade endometrial stromal sarcoma arosen from polypoid endometriosis.
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The histopathological analysis revealed this time a low-grade sarcoma that had arisen in endometriosis with myxoid mesenchymal proliferation (Fig. 4).