A Case of Fertility Sparing Surgery of Low-Grade Endometrial Stromal Sarcoma in Young Female

Low-grade endometrial stromal sarcoma (LGESS) is a rare malignancy. Total hysterectomy and bilateral salpingo-oophorectomy (BSO) were included in the main treatment. The present authors evaluate the feasibility of fertility-sparing management in a patient with low-grade ESS who desired childbearing. The patient aged 24 years presented without symptom. She received laparoscopic myomectomy with endobag morcellation of local resection of the mass with uterine reconstruction. The postoperative pathohistologic analysis showed estrogen receptor (+/-), progesterone receptor (+), then the adjuvant hormonal therapy was given with megestrol acetate 320 mg/day for six months. She received close follow-up which included clinical examination, tumor markers, abdominal and pelvic ultrasound, and yearly pelvic MRI. Thirty-five months after surgery, no evidence of recurrence was observed throughout this period. The authors propose that consider that fertility-sparing treatment is suitable in selected in young LGESS patients, especially for those whose lesion was with a clear borderline. Adjuvant endocrine therapy is reconunended for about six months after operation.