Long-term disease-free survival after bilateral video-assisted thoracoscopic resection of multiple pulmonary metastases from endometrial stromal sarcoma: An 8-year follow-up case report

Background

Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine malignancy prone to late recurrence and distant metastasis, most commonly to the lungs. Bilateral multiple pulmonary metastases are exceedingly uncommon, and optimal management remains unclear.

Case presentation

A 51-year-old woman underwent total abdominal hysterectomy for LG-ESS at age 43. Eight years later, routine chest radiography revealed multiple bilateral pulmonary nodules. Computed tomography showed three well-circumscribed nodules (7–9 mm) in the left S4, left S8, and right S8 segments. Positron emission tomography showed minimal fluorodeoxyglucose uptake. Bilateral video-assisted thoracoscopic wedge resections were performed, achieving complete removal of all lesions. Histopathology confirmed metastatic LG-ESS (CD10/ER/PR positive). The patient received oral medroxyprogesterone acetate for five years. The therapy was discontinued following subarachnoid hemorrhage due to a ruptured posterior-circulation intracranial aneurysm and treated by surgical clipping; she has no residual neurological deficits. She remains disease-free a total of eight years after metastasectomy.

Conclusion

Complete resection of bilateral multiple pulmonary metastases from LG-ESS, combined with hormonal therapy, can achieve durable long-term disease control in carefully selected patients.