Background: Endometrial stromal sarcomas (ESS) are rare uterine sarcomas, and diagnostic difficulties are frequently encountered. Cases: Two premenopausal women were confirmed as having low-grade stromal sarcoma upon histopathological examination, one of them preoperatively and the other postoperatively. Case 1 presented with polymenorrhagia and had a 2×3 cm endocervical polyp that was diagnosed as ESS after polypectomy. She underwent total abdominal hysterectomy and left salpingo-oophorectomy and right salpingectomy, and the hysterectomy specimen showed only adenomatous hyperplasia. Case 2 presented with pain in the abdomen and menorrhagia. She had a mass 24 weeks in size per abdomen and was diagnosed with uterine fibroids with right-leg deep venous thrombosis (DVT). A laparotomy and total abdominal hysterectomy with bilateral salpingo-oophorectomy was undertaken. The right infundibulopelvic and uterine vessels were enlarged markedly and contained white jelly-like material. Histopathological diagnosis was low-grade ESS infiltrating the uterus, right broad ligament, right fallopian tube, right uterine vessels, and cervix. Conclusions: Diagnostic difficulties are common in ESS, and the condition can extend intravenously, mimicking DVT. (J GYNECOL SURG 28:421)
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