Endometrial stromal nodule
| Endometrial stromal nodule | |
|---|---|
 | |
| Endometrial stromal nodule, histology | |
| Specialty | Gynecology, Pathology |
| Symptoms | Usually asymptomatic, abnormal vaginal bleeding, pelvic mass |
| Usual onset | Reproductive to postmenopausal age |
| Duration | Chronic, benign |
| Types | Benign endometrial stromal tumor |
| Causes | Unknown; associated with hypoestrogenism, tamoxifen |
| Risk factors | None specific |
| Diagnostic method | Histopathology, immunohistochemistry (CD10+, desmin−) |
| Differential diagnosis | Leiomyoma, Endometrial stromal sarcoma |
| Treatment | Surgical excision (hysterectomy or conservative) |
| Medication | None specific; hormonal therapy rarely used |
| Prognosis | Excellent after complete excision |
| Frequency | <10% of uterine mesenchymal neoplasms |
| Deaths | None reported |
An endometrial stromal nodule is a noninfiltrative, circumscribed proliferation of endometrial stromal cells and is a benign subtype of endometrial stromal tumor.[1] The appearance of the cells is identical to normal endometrial stromal cells. This can only be differentiated from low-grade endometrial stromal sarcoma by confirming lack of infiltration.[2] These nodules are rare and typically discovered incidentally after hysterectomy, with an excellent prognosis following complete excision.[3]
Clinical features
Patients are usually asymptomatic or present with abnormal vaginal bleeding or a pelvic mass.[1] The tumor is most commonly diagnosed in perimenopausal or postmenopausal women (fifth to sixth decades), though cases have been reported across a wide age range (23–86 years).[4] Endometrial stromal nodules are frequently discovered incidentally after hysterectomy performed for other indications.[3] Rare associations with tamoxifen therapy, radiation exposure, or hypoestrogenic states have been described, though no definitive etiologic factors are established.[5]
Pathology
Gross description
Well-circumscribed, nonencapsulated, soft yellow-tan mass (1–12 cm) with expansile borders.[1]
Microscopic description
Microscopically, the tumor consists of monotonous proliferations of bland endometrial stromal cells resembling proliferative-phase stroma. Characteristic findings include prominent proliferative-type arterioles, collagen bands, and an expansile (non-infiltrative) border. Invasion, if present, is limited to <3 mm and <3 tongue-like protrusions. Mitotic activity is typically low (<10/10 HPF), and angiolymphatic invasion is absent.[1]
Differential diagnosis
The differential includes cellular leiomyoma. Diagnosis may be aided by immunostaining; endometrial stromal nodules are positive for CD10; leiomyomas are positive for caldesmon and desmin (and sometimes CD10).[6]
Treatment and prognosis
Complete surgical excision (usually hysterectomy) is curative, and the prognosis is excellent with no risk of recurrence or metastasis when margins are clear. In select cases where fertility preservation is desired, conservative excision with close hysteroscopic follow-up may be considered, though this approach limits margin assessment.[3]
References
- 1 2 3 4 Jeyachandran, Devi; Desouki, Mohamed Mokhtar (2021-12-02). "Endometrial stromal nodule". PathologyOutlines.com. Retrieved May 1, 2026.
- ↑ Conklin, Christine M.; Longacre, Teri A. (2014). "Endometrial stromal tumors: the new WHO classification". Advances in Anatomic Pathology. 21 (6): 383–393. doi:10.1097/PAP.0000000000000046. PMID 25299308.
- 1 2 3 Porosi, Z.; Wiranegara, H.; Hakim, L. (2015). "Endometrial Stromal Nodule: A Rarity and a Pathological Challenge". Case Reports in Obstetrics and Gynecology. 2015 (4) 376817. doi:10.1155/2015/376817. PMC 4499397. PMID 26180689.
- ↑ Tavassoli, F.A.; Norris, H.J. (1981). "Mesenchymal tumours of the uterus. VII. A clinicopathological study of 60 endometrial stromal nodules". Histopathology. 5 (1): 1–22. doi:10.1111/j.1365-2559.1981.tb01794.x. PMID 7227849.
- ↑ An, J.; Ruan, G.; Xie, X.Y.; Shi, Y.Q.; Mao, X.D.; Dong, B.H.; Sun, P.M. (2020). "Endometrial stromal nodule: report of 8 cases and literature review". European Journal of Gynaecological Oncology. 41 (3): 332–338. doi:10.31083/j.ejgo.2020.03.5039.
- ↑ Nucci, Marisa R.; O'Connell, James T.; Huvos, Andrew G.; Fletcher, Christopher D.; Young, Robert H. (2002). "An immunohistochemical analysis of endometrial stromal and smooth muscle tumors of the uterus: the utility of CD10 in distinguishing endometrial stromal tumors from smooth muscle tumors". International Journal of Gynecological Pathology. 21 (1): 10–17. doi:10.1097/00004347-200201000-00003. PMID 11914617.