Chin Tzu-Hsuan, Lin Gigin, Wu Ren-Chin, Lai Chyong-Huey
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Obstet Gynaecol Res. 2018 Sep;44(9):1836-1842. doi: 10.1111/jog.13695. Epub 2018 Jul 5.
Considering the characteristics of low-grade endometrial stromal sarcoma (ESS), such as relative indolent course, younger age at diagnosis and favorable prognosis, the fertility-preserving management of low-grade ESS has been described by several authors. We report a 34-year-old female with stage IB low-grade ESS who developed recurrence 7 years after neoadjuvant high-dose progestin therapy followed by fertility-preserving surgery and postoperative progestin therapy. The patient stopped progestin therapy and was disease free for 4 years after diagnosis but experienced recurrence with peritoneal dissemination at 7 years. Considering the tendency of late recurrence, long-term surveillance is necessary to ensure timely action. Long-term progestin treatment might be considered after complete remission even beyond 5 years. We performed a literature review and found that many of the cases did not meet solid pathological criteria of low-grade ESS. The diagnostic criteria of low-grade ESS (vs endometrial stromal nodule) should be deliberately documented for future studies of this rare disease.
考虑到低级别子宫内膜间质肉瘤（ESS）的特点，如病程相对惰性、诊断时年龄较轻以及预后良好，已有多位作者描述了低级别ESS的保留生育功能管理。我们报告了一名34岁患有IB期低级别ESS的女性，她在新辅助大剂量孕激素治疗后接受了保留生育功能手术及术后孕激素治疗，7年后出现复发。该患者在诊断后停止了孕激素治疗，4年无病，但在7年时出现腹膜播散复发。考虑到晚期复发的趋势，有必要进行长期监测以确保及时采取行动。即使在完全缓解超过5年后，也可考虑长期孕激素治疗。我们进行了文献综述，发现许多病例不符合低级别ESS的可靠病理标准。对于这种罕见疾病的未来研究，应谨慎记录低级别ESS（与子宫内膜间质结节相比）的诊断标准。
