Endometrial stromal nodule

Endometrial Stromal Nodule (ESN) is a rare, benign tumor of the uterus, specifically arising from the endometrial stroma. Unlike its malignant counterparts, endometrial stromal sarcoma and undifferentiated uterine sarcoma, ESN is characterized by its limited growth potential and lack of infiltration into surrounding tissues. This article provides an overview of the clinical presentation, diagnosis, and management of endometrial stromal nodules.

Clinical Presentation

Patients with an endometrial stromal nodule may present with a variety of symptoms, or the condition may be asymptomatic and discovered incidentally during a pelvic examination or imaging for another reason. When symptoms are present, they may include abnormal uterine bleeding, pelvic pain, and pressure symptoms due to the mass effect of the nodule on adjacent structures.

Diagnosis

The diagnosis of an endometrial stromal nodule is primarily based on histological examination. Imaging techniques such as ultrasound and magnetic resonance imaging (MRI) can suggest the presence of a uterine mass but cannot definitively distinguish ESN from other uterine tumors.

Histopathology

Histologically, ESN is characterized by a well-circumscribed nodule of endometrial stromal cells with little or no mitotic activity. The nodule is typically surrounded by a thin rim of compressed myometrium. Unlike endometrial stromal sarcomas, ESNs do not exhibit infiltration into the surrounding myometrium or vascular invasion.

Management

The management of endometrial stromal nodules typically involves surgical removal, either by hysterectomy or myomectomy, depending on the patient's age, desire for fertility, and the size and location of the nodule. Given the benign nature of ESN, the prognosis after complete surgical excision is excellent, with a very low risk of recurrence.

Differential Diagnosis

The differential diagnosis for endometrial stromal nodule includes other uterine masses such as leiomyomas, adenomyosis, and malignant tumors like endometrial stromal sarcoma. Histopathological examination is crucial for accurate diagnosis.

Epidemiology

Endometrial stromal nodules are rare, and their exact incidence is not well-documented. They can occur in women of any age but are most commonly diagnosed in premenopausal women.

Conclusion

Endometrial stromal nodules are rare, benign uterine tumors with a favorable prognosis following surgical removal. Their diagnosis relies heavily on histopathological examination, distinguishing them from other, potentially malignant, uterine masses. Management typically involves surgical excision, with a very low risk of recurrence.