Gu YZ, Duan NY, Cheng HX, Xu LQ, Meng JL. Fertility-sparing surgeries without adjuvant therapy through term pregnancies in a patient with low-grade endometrial stromal sarcoma: A case report. World J Clin Cases 2021; 9(4): 983-991 [PMID: 33585648 DOI: 10.12998/wjcc.v9.i4.983]
Corresponding Author of This Article
Jin-Lai Meng, MD, PhD, Chief Physician, Professor, Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan 250021, Shandong Province, China. sdslyymjl@163.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yong-Zhong Gu, Jin-Lai Meng, Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Yong-Zhong Gu, Lian-Qiong Xu, Jin-Lai Meng, Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
Ning-Ya Duan, Department of Obstetrics and Gynecology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Hong-Xia Cheng, Department of Pathology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Author contributions: Gu YZ and Duan NY contributed equally to the report, collected the patient’s clinical data, and performed the systematic review; Cheng HX made important intellectual contributions to pathological diagnosis and revised the manuscript; Xu LQ edited and revised the manuscript; Meng JL designed the report and wrote the paper; all authors read and approved the final manuscript.
Supported byOpen Foundation of Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, No. 2018KF003.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Lai Meng, MD, PhD, Chief Physician, Professor, Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan 250021, Shandong Province, China. sdslyymjl@163.com
Received: November 10, 2020 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
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
