Introduction/Background Case report: we present a case of 48 yr old single lady presenting with weakness, severe anemia and abnormal uterine bleeding and large pelvic mass of 30 week size. Ultrasound abdomen and pelvis : showed Mild right hydronephrosis; large heterogeneous lesion in pelvis likely to suggest a ?fibroid. MRI showed large posterior wall fibroid presenting as pelvi abdominal mass with cystic and hyaline degeneration for excision and pathological confirmation to rule out sarcomatous change. As patient was single she requested conservative surgery. She was counseled about the risk of hemorrhage and need for hysterectomy and underwent total abdominal hysterectomy with removal of tubes and ovaries.

Histopathological examination showed undifferentiated endometrial sarcoma (high grade) in background of atrophic endometrium and leiomyomata uteri

Post surgery she was investigated with oncology and multidisciplinary team and CT scan of abdomen and pelvis showed lung metastasis.

Patient was counseled but she was in denial and did not attend for follow up and palliative surgery.

Methodology Case report

Results Histology slides and MRI slides will be uploaded in the poster

Conclusion High grade endometrial stromal sarcoma is rare but serious diagnosis. High Degree of suspicion pre operatively specially in large fibroids and patient requesting conservative surgeries is required.

We present this case due to its rarity and difficulty in managing the patient pre and post operatively as she was requesting conservative surgery pre operatively and due to denial failed to continue post operative follow up and therapy. Also this case again emphasized that most of this cases present as common perimenopausal complaints like abnormal menstrual bleeding and pelvic masses and diagnosed in late stage of disease which carries poor prognosis. Therefore high degree of suspicision is required for early diagnosis, counseling and management of such cases.

Disclosure Nothing to disclose