Fertility sparing surgery in young women affected by endometrial stromal sarcoma: an oncologic dilemma or a reliable option? review of literature starting from a peculiar case

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. CASE PRESENTATION: 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. CONCLUSION: 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.