Endometrial stromal sarcoma with selective polyvinyl alcohol embolization of a pulmonary metastasis after recurrent hemoptysis and expansive growth

A 63-year-old female with a well-vascularized pulmonary metastasis of an endometrial stromal sarcoma (ESS) of 6×6 cm received selective embolization with 150–250 μm polyvinyl alcohol (Contour; Boston Scientific, Natick, MA, USA) via a bronchial artery. Post-interventional loss of perfusion was qualitatively estimated to be >80%. The lesion was located in direct proximity to the pulmonary hilar vessels. Owing to recurrent and sudden hemoptyses, an interdisciplinary tumor board assessed the risk of life-threatening blood loss to be greater than that of angiography with particle embolization and agreed on an endovascular approach. Hemoptysis did not recur in a follow-up period of six months. Initial clinical symptoms were noted 25 years ago. However, establishing a definite diagnosis has, for a long time, remained a histopathological challenge.