Post-hysterectomy presentation of low-grade endometrial stromal sarcoma (LGESS): a clinical challenge in uterine malignancies.

Endometrial stromal sarcoma (ESS) is a rare uterine malignancy originating from endometrial connective tissue. It is classified into benign and malignant subtypes. While it primarily affects perimenopausal women aged 45-55 years, younger patients may also be affected. ESS often presents with symptoms such as abnormal uterine bleeding, pelvic pain or pelvic mass, mimicking benign conditions like fibroids. Definitive treatment includes total hysterectomy with bilateral salpingo-oophorectomy, complemented by hormonal therapy for advanced cases.Despite its indolent nature, low-grade ESS (LGESS) requires long-term follow-up due to significant recurrence risk. We present a case of a woman in her late 20s, who underwent hysterectomy for severe bleeding and anaemia, with LGESS diagnosed later during a growing abdominal wall mass evaluation.Imaging and biopsy confirmed her diagnosis. She underwent extensive debulking surgery. Histological analysis revealed oval to spindle cells, low mitotic activity, no necrosis or atypical mitotic figures; Estrogen Receptor (ER), Progesterone Receptor (PR) and CD10 positivity, which were consistent with LGESS.