Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.983
Peer-review started: November 10, 2020
First decision: November 23, 2020
Revised: November 30, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: February 6, 2021
Processing time: 75 Days and 19.7 Hours
Low-grade endometrial stromal sarcoma (LGESS) is a rare indolent tumor with a favorable prognosis. With the importance of improving quality of life recognized, fertility-sparing surgery may be an option for those young women. However, most of the reports suggested that stage IA patients might be candidates for fertility-sparing surgery, and adjuvant hormonal treatment was considered a feasible adjuvant therapy for reducing the recurrence risk of patients with LGESS and hysterectomy was recommended after the completion of pregnancy and delivery.
A 28-year-old pregnant woman diagnosed with stage IB LGESS was treated by fertility-sparing surgery when term cesarean section delivery was performed. Without any adjuvant treatment, she had the other successful term pregnancy and cesarean section 45 mo after first fertility-sparing surgery. Moreover, only hysteroscopic resection was performed to retain fertility again even when the tumor recurred after 6 years. So far the patient’s fertility and disease-free status have remained for more than 8 years without any adjuvant therapy despite local resection of the sarcoma. And the two babies were in good health.
For young patients with stage I LGESS, it seems that repeated fertility-sparing surgeries could be performed even after two term deliveries and the tumor recurrence, and it might be attempted without adjuvant therapy but the counseling should be considered as mandatory.
Core Tip: Low-grade endometrial stromal sarcoma (LGESS) is an indolent tumor and fertility-sparing surgery may be an option for young women. However, hysterectomy and adjuvant therapy were recommended after the delivery completion. We present a pregnant LGESS woman who was treated by fertility-sparing surgery at term delivery. She had the other successful term pregnancy after 45 mo. Moreover, only hysteroscopic resection was performed to retain fertility again when the tumor recurred after 6 years. Her fertility and disease-free status have remained for more than 8 years without adjuvant therapy. This case represents the first attempt of fertility-sparing surgery even after two term deliveries and the tumor recurrence and an attempt of no adjuvant therapy for young patients with LGESS.