背景:子宫内膜间质肉瘤(ESS)是一个术语,用于定义一种罕见的肿瘤,约占所有子宫恶性肿瘤的0.2%-1%;它是,然而,估计有10%-15%的具有间充质成分的恶性肿瘤。最近的证据表明,虽然在绝经前妇女中保留卵巢可能被认为是适当的,子宫切除术和双侧输卵管卵巢切除术仍然是绝经后妇女的推荐治疗方法。目前,文献中只有少数病例系列报道了希望保留生育能力并因此接受保留生育能力手术的年轻女性的ESS治疗.
方法:我们报告了一个特殊的早期ESS病例,通过腹腔镜保留生育功能的手术和严格的随访程序(每3个月)进行影像学和临床评估。患者在初次治疗后1年保持无病。完成肿瘤随访三个月后,病人是自发受孕的,到目前为止,在妊娠11周时怀孕,没有复发性疾病或产科并发症的证据。
结论:根据我们的病例报告和现有数据,我们建议在受早期ESS影响的年轻患者中,希望保留生殖功能,保留生育能力的手术可能是一个有效的选择,尽管严格的肿瘤随访仍然是强制性的。
BACKGROUND: 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.
METHODS: 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.
CONCLUSIONS: 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.