Conservative management of endometrial stromalsarcoma in young women

Lissoni A, Cormio G, Perego P, Gabriele A, Cantú MG, Bratina G.Conservative management of endometrial stromal sarcoma in young women. Int J Gynecol Cancer 1997; 7 : 364–367.
Endometrial stromal sarcoma (ESS) is a rare malignancy with an associatedpoor prognosis. Total abdominal hysterectomy is considered the treatment ofchoice, and the role ofconservative, fertility-sparing surgery in young patients desiring pregnancy isnot well-defined.
Six patients were managed conservatively for ESS between 1982 and 1996 atour institution. The sources of tissue for diagnosis were polyps or myomasremoved for relief ofsymptoms. Median age of the patients was 27 years (range 18–36), and allwere nulliparous. One patient had a high-grade ESS (12 mitoses per 10 HPF) withextensive necrosis andatypia. The remaining five patients had a low-grade ESS, with a median mitoticcount of 4 per 10 HPF (range 2–6). In all cases the tumor was completelyresected, with a saferesection margin of at least 2 mm. No patients received adjuvant treatment.
At a median follow-up of 51 months (range 12–84) all patients arealive and well without recurrence. Two patients (33%) had a spontaneousdelivery at term, whereas one patient had a miscarriage at the 8th week ofgestation.
Conservative management of endometrial stromal sarcoma may be attempted inselected patients desiring pregnancy. Adequate follow-up is mandatory in orderto detect recurrence assoon as possible. Considering the indolent growth of low-grade ESS, definitivesurgery can be postponed until after completion of the reproductivefunction.