All uterine enlargements are not fibroids!

Endometrial stromal sarcomas are rare mesenchymal tumors observed in pre- and peri-menopausal age group. The diagnosis is made postoperatively, but a high index of suspicion is needed. The usual presentation is lump in abdomen and abnormal vaginal bleeding. Endometrial sampling, ultrasound, and magnetic resonance imaging help in preoperative diagnosis. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the main line of management. This article describes its occurrence in a young woman, who presented without the usual clinical features of lump or abnormal vaginal bleeding. The diagnosis was established postoperatively and was confirmed with specialized tests such as immunohistochemistry and mutation studies.