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Large malignant uterine tumors have varied presentation and have overlapping features due to endo-myometrial involvement. Few characteristic features, on Ultrasound and MRI, especially with T2Wt images, seen as hypointense bands within the tumor with the bag of worms appearance, give clues to consider endometrial stromal sarcoma as one of the differential diagnoses.






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Endometrial stromal sarcoma: An aggressive uterine malignancy

Free full text article: Endometrial stromal sarcoma:  An aggressive uterine malignancy

Abstract
Endometrial stromal sarcoma (ESS) is an aggressive uterine sarcoma. We report a case of a large endometrial stromal sarcoma in a 42 year nulliparous woman with chronic kidney disease presenting with acute urinary retention and irregular per vaginal bleeding. Ultrasound and Doppler imaging revealed a heterogeneous mass in the endometrial cavity with internal vascularity. Magnetic resonance imaging (MRI) revealed a large lobulated mass in the endometrial cavity extending into the vagina, causing local mass effect. Multiple linear hypointense bands on magnetic resonance T2 weighted (T2wt) images were characteristic of ESS. MRI is a very useful imaging modality in characterizing the lesion and also for the staging. It is necessary to distinguish these tumors from benign as well as other uterine malignancies for better management. We also review relevant literature discussing imaging findings of ESS.






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