Successful pregnancy following conservative management of low-grade endometrial stromal sarcoma: A case report

Ruiying Dong, Yingxin Pang, Hongluan Mao, Ning Yang, Peishu Liu, Ruiying Dong, Yingxin Pang, Hongluan Mao, Ning Yang, Peishu Liu

Abstract

It is uncommon that fertility is preserved in young nulliparous females with low-grade endometrial stromal sarcoma (ESS). Therefore, successful pregnancy following such conservative management has been rarely reported in previous literature. A 25-year-old female (gravida, 0; para, 0) underwent hysteroscopic surgery and was pathologically diagnosed with an endometrial stromal nodule. The patient underwent fertility-preserving local resection and uterine reconstruction, with a final pathological diagnosis of low-grade ESS. Endocrine therapy was then administered. Conservative management resulted in the complete remission of low-grade ESS. The patient naturally conceived and successfully delivered a healthy baby at 42 weeks' gestation by cesarean section, ~30 months following diagnosis with low-grade ESS. In conclusion, conservative management, including fertility-preserving local mass resection and endocrine therapy, can be effective for low-grade ESS and may yield a favorable outcome for young nulliparous females desiring fertility preservation.

Keywords: endocrine therapy; endometrial stromal sarcoma; fertility-preserving surgery; pregnancy.

Figures

Figure 1
Figure 1
Microscopic and immunohistochemical features of the resected tissue (magnification, ×20). (A) Invasion of the myometrium by endometrial stromal sarcoma. Tumor cells showed CD10 positivity and SMA negativity. White arrow indicates the area of stromal sarcoma cells infiltrating the myometrium. Black arrow indicates that the blood vessel wall was markedly positive for SMA, as a positive control, while tumor cells revealed SMA negativity. (B) Strong positivity for estrogen receptor and progesterone receptor in the nucleus of stromal sarcoma cells (brown). SMA, smooth muscle actin.

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