Endometrial stromal sarcoma in a patient with ulcerative colitis receiving immunosuppressive therapy - A case report and review of literature

Q: What clinical situation does the case report describe?

The report describes a patient with ulcerative colitis receiving immunosuppressive therapy who was diagnosed with endometrial stromal sarcoma.

Q: Which UC treatments were involved in the patient’s management?

The patient used aminosalicylates and azathioprine initially, then started infliximab plus azathioprine, later considered vedolizumab, with escalation to surgery due to persistent disease activity and prior neoplasia history.

Q: Why is cancer risk emphasized in this report?

Inflammatory bowel disease carries a higher cancer risk related to chronic inflammation and/or treatment. The case highlights the need for appropriate screening and multidisciplinary care to improve outcomes.

Sep 28, 2026

Uploaded by Aditya

Ulcerative colitis (UC) is a chronic inflammatory bowel disease managed with immunosuppressants to control inflammation. Azathioprine and anti-tumor necrosis factor agents increase the risk of extraintestinal malignancies, yet an established link to endometrial stromal sarcoma remains unproven. This case report describes a 49-year-old woman with UC treated with immunosuppressive therapy who developed a rare endometrial stromal sarcoma, and reviews literature exploring potential correlation among UC, therapies, and tumor development.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

CASE REPORT

Background

Case summary

Conclusion

Core Tip

| W | J | C | C | World Journal of
Clinical Cases | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Cases 2025 December 16; 13(35): 114672 DOI: 10.12998/wjcc.v13.i35.114672 ISSN 2307-8960 (online) CASE REPORT Endometrial stromal sarcoma in a patient with ulcerative colitis receiving immunosuppressive therapy: A case report and review of literature Ada Alexandrina Brom dos Santos Soares, Thais Gagno Grillo, Lívia Cafundó Almeida, Gabriel S Thiago Cavalleiro, Marina Amorim Lopes, Marcela Maria Silvino Craveiro, Giedre Soares Prates Herrerias, Júlio Pinheiro Baima, Rogerio Saad-Hossne, Ligia Yukie Sassaki Specialty type: Medicine, research and experimental Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B Novelty: Grade B Creativity or Innovation: Grade B Scientific Significance: Grade B P-Reviewer: Lin HX, MD, PhD, Associate Chief Physician, Associate Professor, Postdoctoral Fellow, China Received: September 28, 2025 Revised: October 25, 2025 Accepted: December 1, 2025 Published online: December 16, 2025 Processing time: 79 Days and 6.6 Hours Ada Alexandrina Brom dos Santos Soares, Thais Gagno Grillo, Lívia Cafundó Almeida, Gabriel S Thiago Cavalleiro, Giedre Soares Prates Herrerias, Júlio Pinheiro Baima, Ligia Yukie Sassaki, Department of Internal Medicine, Medical School, São Paulo State University (UNESP), Botucatu 18618687, São Paulo, Brazil Marina Amorim Lopes, Marcela Maria Silvino Craveiro, Rogerio Saad-Hossne, Department of Surgery, Medical School, São Paulo State University (UNESP), Botucatu 18618687, São Paulo, Brazil Corresponding author: Thais Gagno Grillo, PhD, Department of Internal Medicine, Medical School, São Paulo State University (UNESP), Av. Prof. Mário Rubens Guimarães Montenegro, Botucatu 18618687, São Paulo, [Brazil.](Brazil. thais.gagno@unesp.br)[ thais.gagno@unesp.br](Brazil. thais.gagno@unesp.br) Abstract BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory bowel disease treated with immunosuppressants to control inflammation. Drugs like azathioprine (AZA) and anti-tumor necrosis factor agents increase the risk of extraintestinal malignancies. However, no association has been established between these therapies and endometrial stromal sarcoma. This report presents a rare case of endometrial stromal sarcoma in a patient with UC undergoing immunosuppressive treatment and includes a literature review to explore any possible correlation between the disease, the therapies used, and the development of this rare tumor. CASE SUMMARY Female, 49 years old, with UC pancolitis extension since 2017. She used aminosalicylates and AZA with non-response. She started infliximab and AZA combination therapy in 2020, with optimization in 2021 due to endoscopic activity. In the same year, the patient presented to the emergency room with ascitis and underwent diagnostic paracentesis, which showed serum-ascites albumin gradient < 1.1 g/dL, absence of neoplastic cells, and abdominal and pelvic tomography reported a hypoechoic nodular lesion in the posterior wall of the uterus and elevated carbohydrate antigen 125. Given the suspicion of neoplasia, the suspension of immunosuppressive therapy was indicated. The patient underwent a total abdo- WJCC [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 16, 2025 Volume 13 Issue 35 Soares AABS et al. Endometrial sarcoma in a UC patient minal hysterectomy and bilateral salpingo-oophorectomy, and the pathological result reported low-grade endometrial sarcoma. It was decided to introduce vedolizumab for the management of UC; however, even after induction therapy, intense clinical and endoscopic disease activity was maintained, with total proctocolectomy being indicated due to clinical refractoriness and a hist

FAQs

What clinical situation does the case report describe?

The report describes a patient with ulcerative colitis receiving immunosuppressive therapy who was diagnosed with endometrial stromal sarcoma.

Which UC treatments were involved in the patient’s management?

The patient used aminosalicylates and azathioprine initially, then started infliximab plus azathioprine, later considered vedolizumab, with escalation to surgery due to persistent disease activity and prior neoplasia history.

Why is cancer risk emphasized in this report?

Inflammatory bowel disease carries a higher cancer risk related to chronic inflammation and/or treatment. The case highlights the need for appropriate screening and multidisciplinary care to improve outcomes.

Sep 28, 2026

Uploaded by Aditya