Noventa Marco, Gizzo Salvatore, Conte Lorena, Dalla Toffola Angela, Litta Pietro, Saccardi Carlo
Department of Woman and Child Health, University of Padua, Padua, Italy.
Onco Targets Ther. 2014 Dec 18;8:29-35. doi: 10.2147/OTT.S69507. eCollection 2015.
Endometrial stromal sarcoma (ESS) is a term used to define a rare neoplasm that accounts for approximately 0.2%-1% of all uterine malignancies; it is, however, implicated in an estimated 10%-15% of those malignancies with a mesenchymal component. Recent evidence suggests that while the preservation of the ovaries may be considered appropriate in premenopausal women, hysterectomy and bilateral salpingo-oophorectomy remains the recommended treatment in postmenopausal women. Currently, only a few case series reporting the treatment of ESS in young women with a desire to preserve fertility and thus subjected to a fertility-sparing surgery are available in the literature.
We report a peculiar case of early stage ESS treated by laparoscopic fertility-sparing surgery and a strict follow-up program (every 3 months) of imaging and clinical evaluation. The patient remained disease free 1 year after primary treatment. Three months after completing oncological follow-up, the patient conceived spontaneously and is, to date, pregnant at 11 weeks of gestation without evidence of recurrent disease or obstetric complications.
Based on our case report and in accordance with the data available, we suggest that in young patients affected by early stage ESS who wish to preserve reproductive function, fertility-sparing surgery could represent a valid option, though strict oncological follow-up remains mandatory.
子宫内膜间质肉瘤（ESS）是用于定义一种罕见肿瘤的术语，约占所有子宫恶性肿瘤的0.2%-1%；然而，在估计10%-15%有间叶成分的子宫恶性肿瘤中可发现该肿瘤。近期证据表明，虽然对于绝经前女性保留卵巢可能被认为是合适的，但子宫切除术和双侧输卵管卵巢切除术仍是绝经后女性的推荐治疗方法。目前，文献中仅有少数病例系列报道了对有生育愿望的年轻女性ESS进行保留生育功能手术的治疗情况。
我们报告了一例早期ESS的特殊病例，该病例接受了腹腔镜保留生育功能手术及严格的随访计划（每3个月进行一次），包括影像学和临床评估。初次治疗后1年，患者无疾病复发。完成肿瘤学随访3个月后，患者自然受孕，截至目前，已妊娠11周，无疾病复发迹象或产科并发症。
基于我们的病例报告并根据现有数据，我们建议对于希望保留生殖功能的早期ESS年轻患者，保留生育功能手术可能是一种有效的选择，不过严格的肿瘤学随访仍然必不可少。
