Gu Yong-Zhong, Duan Ning-Ya, Cheng Hong-Xia, Xu Lian-Qiong, Meng Jin-Lai
Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China.
Department of Obstetrics and Gynecology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
World J Clin Cases. 2021 Feb 6;9(4):983-991. doi: 10.12998/wjcc.v9.i4.983.
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.
低级别子宫内膜间质肉瘤（LGESS）是一种罕见的惰性肿瘤，预后良好。随着提高生活质量的重要性得到认可，保留生育功能手术可能是年轻女性的一种选择。然而，大多数报告表明，IA期患者可能是保留生育功能手术的候选人，辅助激素治疗被认为是降低LGESS患者复发风险的可行辅助治疗方法，建议在妊娠和分娩结束后进行子宫切除术。
一名28岁诊断为IB期LGESS的孕妇在足月剖宫产时接受了保留生育功能手术治疗。在未进行任何辅助治疗的情况下，她在首次保留生育功能手术后45个月再次成功足月妊娠并进行了剖宫产。此外，即使肿瘤在6年后复发，也仅进行了宫腔镜切除术以再次保留生育功能。到目前为止，尽管对肉瘤进行了局部切除，但患者在未进行任何辅助治疗的情况下，生育功能和无病状态已保持超过8年。并且两个婴儿健康状况良好。
对于I期LGESS的年轻患者，似乎即使在两次足月分娩和肿瘤复发后仍可进行反复的保留生育功能手术，并且在不进行辅助治疗的情况下也可尝试，但应将咨询视为强制性的。
