Hemorrhagic brain metastasis of endometrial stromal sarcoma

High-grade endometrial stromal sarcoma is a rare uterine malignancy. The cells of these tumors resemble endometrial cells in the proliferation stage, with many small plexiform arterioles. Herein we present a patient with endometrial stromal sarcoma that metastasized to the brain, along with the CT and MRI findings and a discussion of the surgical and histopathological features of the metastatic tumor. Immunohistopathological examination of the metastatic tumor showed a high mitotic rate and strong immunopositivity for CD10 and vimentin (as a mesenchymal marker); therefore, the lesion was considered to be high-grade endometrial stromal sarcoma. Due to the rarity of reported cases of metastatic brain tumors of high-grade endometrial stromal sarcoma, there isn’t a standard treatment protocol; however, metastatic tumors of high-grade endometrial stromal sarcoma match the same general concepts of brain metastasis. In addition, endometrial stromal sarcomas may be associated with hemorrhagic metastasis to the brain due to their pathologic characteristics.