low grade extrauterine endometrial stromal sarcoma arising from peritoneum endometriosis: a case report and literature review

Introduction: endometrial stromal sarcoma (ess) is an uncommon condition that accounts for approximately 0.2% of all reproductive tract malignancies. among the various subtypes of ess, low-grade extrauterine endometrial stromal sarcoma (lg-eess) is even rarer and has only been reported in a limited number of case studies. case presentation: we reported a case of lg-eess in a 35-year-old woman with a five-year history of stage iv endometriosis. the patient presented with chronic abdominopelvic pain and dysmenorrhea. transvaginal ultrasound showed bilateral tubo-ovarian complexes with multicystic structures, while mri revealed solid lesions with t1 iso signal, t2 hypersignal, and diffusion restriction, indicating metastatic implantation extending to the peritoneum and subhepatic region. a core needle biopsy confirmed lg-eess, and immunohistochemistry showed cd10 positivity, aiding in the diagnosis and distinguishing it from other tumors. conclusions: our case highlights the potential utility of preoperative diagnostic imaging, particularly mri, in the evaluation of lg-eess. additionally, it emphasizes the importance of considering the possibility of extrauterine ess, as this tumor exhibits histopathological features and clinical behavior similar to its uterine counterpart.