What is your treatment approach to a young woman with widely metastatic low grade endometrial stromal sarcoma not amenable to complete cytoreduction?

Widely metastatic low-grade ESS in a young woman is quite rare - would suggest pathology confirmation as a first step along with cytogenics/to evaluate for diagnostic fusions in this entity.

Is the pattern in the abdm/pelvis? Or are there lung or other mets as well?

The most effective approach/guideline-concordant approach for metastatic low-grade ESS is hormonal suppression - in a pre-menopausal woman, this could include bilateral oophorectomy or medical ovarian suppression with concurrent estr...