Conservative management of endometrial stromalsarcoma in young women

Abstract

Lissoni A, Cormio G, Perego P, Gabriele A, Cantú MG, Bratina G. Conservative management of endometrial stromal sarcoma in young women. Int J Gynecol Cancer 1997; 7: 364-367. Endometrial stromal sarcoma (ESS) is a rare malignancy with an associated poor prognosis. Total abdominal hysterectomy is considered the treatment of choice, and the role of conservative, fertility-sparing surgery in young patients desiring pregnancy is not well-defined. Six patients were managed conservatively for ESS between 1982 and 1996 at our institution. The sources of tissue for diagnosis were polyps or myomas removed for relief of symptoms. Median age of the patients was 27 years (range 18-36), and all were nulliparous. One patient had a highgrade ESS (12 mitoses per 10 HPF) with extensive necrosis and atypia. The remaining five patients had a low-grade ESS, with a median mitotic count of 4 per 10 HPF (range 2-6). In all cases the tumor was completely resected, with a safe resection margin of at least 2 mm. No patients received adjuvant treatment. At a median follow-up of 51 months (range 12-84) all patients are alive and well without recurrence. Two patients (33%) had a spontaneous delivery at term, whereas one patient had a miscarriage at the 8th week of gestation. Conservative management of endometrial stromal sarcoma may be attempted in selected patients desiring pregnancy. Adequate follow-up is mandatory in order to detect recurrence as soon as possible. Considering the indolent growth of low-grade ESS, definitive surgery can be postponed until after completion of the reproductive function.

Successful Pregnancy with Endometrial Stromal Sarcoma (ESS)

“…Lei Yan et al reported a case of successful pregnancy after conservative treatment of ESS in a 25-year-old woman. TAH is the treatment of choice in these patients, but conservative management may be attempted in selected patients desiring pregnancy [3]. Considering the indolent growth of low grade ESS, definitive surgery can be postponed until after completion of reproductive function.…”

“…ESS can be mistaken for leiomyoma because clinical presentation mimics each other and often needs HPE to establish correct diagnosis [2,3]. In this article, we report a case of ESS in a young unmarried female of 23 years, which was misdiagnosed as leiomyoma, but the patient was able to conceive and deliver a healthy baby after debulking surgery to remove myoma was mistakenly done.…”

Fatal case of multiple recurrences of endometrial stromal sarcoma after fertility‐sparing management

“…However, fertility‐sparing management is sometimes attempted for nulliparous young women, although the success of conservative management is unclear. Several ‘successful’ cases of the uterus being preserved after diagnosis of ESS have been reported after a short follow‐up period . Here, we report a fatal case after long‐term follow‐up.…”

“…Several 'successful' cases of the uterus being preserved after diagnosis of ESS have been reported after a short follow-up period. [2][3][4][5][6][7][8] Here, we report a fatal case after long-term follow-up.…”

Fertility preservation in gynecologic cancer

“…Careful monitoring with sonography followed by a ‘second‐look’ hysteroscopy and curettage is recommended. Pregnancy should then be allowed as soon as possible even through assisted reproductive therapy (76).…”