Fertility-sparing management of low-grade endometrial stromal sarcoma: analysis of an institutional series and review of the literature

Laurelli, Giuseppe; Falcone, Francesca; Scaffa, Cono; Em, Messalli; Giudice, M; Losito, Simona; Greggi, Stefano

doi:10.1016/j.ejogrb.2015.09.041

Cited by 28 publications

(31 citation statements)

References 25 publications

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“…There is limited preliminary data on fertility sparing approach in young women with ESS after hysteroscopic resection; currently this approach should only be considered within the context of research studies (194).…”

Section: Surgical Treatmentmentioning

confidence: 99%

BGCS uterine cancer guidelines: Recommendations for practice

Sundar¹,

Balega²,

Crosbie³

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

126

174

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Section: Surgical Treatmentmentioning

confidence: 99%

BGCS uterine cancer guidelines: Recommendations for practice

Sundar¹,

Balega²,

Crosbie³

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

126

174

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show abstract

“…The surgical treatment of endometrial stromal sarcoma is hysterectomy and bilateral salpingo‐oophorectomy. However, in young patients affected by early‐stage endometrial stromal sarcoma who wish to preserve reproductive function, fertility‐sparing surgery (hysteroscopic removal of the lesion and sparing of the uterus and ovaries) is an option. Endometrial stromal sarcomas are usually hormone receptor‐positive, and progestins and aromatase inhibitors are used as adjuvant treatment in these cases.…”

Section: Introductionmentioning

confidence: 99%

Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma

Ludovisi

Moro

Pasciuto

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To describe the clinical and ultrasound characteristics of uterine sarcomas. Methods This was a retrospective multicenter study. From the databases of 13 ultrasound centers, we identified patients with a histological diagnosis of uterine sarcoma with available ultrasound reports and ultrasound images who had undergone preoperative ultrasound examination between 1996 and 2016. As the first step, each author collected information from the original ultrasound reports from his/her own center on predefined ultrasound features of the tumors and by reviewing the ultrasound images to identify information on variables not described in the original report. As the second step, 16 ultrasound examiners reviewed the images electronically in a consensus meeting and described them using predetermined terminology. Results We identified 116 patients with leiomyosarcoma, 48 with endometrial stromal sarcoma and 31 with undifferentiated endometrial sarcoma. Median age of the patients was 56 years (range, 26–86 years). Most patients were symptomatic at diagnosis (164/183 (89.6%)), the most frequent presenting symptom being abnormal vaginal bleeding (91/183 (49.7%)). Patients with endometrial stromal sarcoma were younger than those with leiomyosarcoma and undifferentiated endometrial sarcoma (median age, 46 years vs 57 and 60 years, respectively). According to the assessment by the original ultrasound examiners, the median diameter of the largest tumor was 91 mm (range, 7–321 mm). Visible normal myometrium was reported in 149/195 (76.4%) cases, and 80.0% (156/195) of lesions were solitary. Most sarcomas (155/195 (79.5%)) were solid masses (> 80% solid tissue), and most manifested inhomogeneous echogenicity of the solid tissue (151/195 (77.4%)); one sarcoma was multilocular without solid components. Cystic areas were described in 87/195 (44.6%) tumors and most cyst cavities had irregular walls (67/87 (77.0%)). Internal shadowing was observed in 42/192 (21.9%) sarcomas and fan‐shaped shadowing in 4/192 (2.1%). Moderate or rich vascularization was found on color‐Doppler examination in 127/187 (67.9%) cases. In 153/195 (78.5%) sarcomas, the original ultrasound examiner suspected malignancy. Though there were some differences, the results of the first and second steps of the analysis were broadly similar. Conclusions Uterine sarcomas typically appear as solid masses with inhomogeneous echogenicity, sometimes with irregular cystic areas but only very occasionally with fan‐shaped shadowing. Most are moderately or very well vascularized. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…Considering relative indolent course and better prognosis of low‐grade ESS, fertility‐preserving treatment might be possible. Fertility‐sparing surgery for young women with ESS has been reported in a few case reports . Some achieved successful pregnancies, while others ended up recurrences.…”

Section: Introductionmentioning

confidence: 99%

“…Fertility-sparing surgery for young women with ESS has been reported in a few case reports. [7][8][9][10][11][12][13][14][15][16] Some achieved successful pregnancies, while others ended up recurrences. Experiences of conservative management in low-grade ESS are still limited.…”

Section: Introductionmentioning

confidence: 99%

Recurrence after fertility‐preserving surgery for low‐grade endometrial stromal sarcoma

Chin

Lin

et al. 2018

J of Obstet and Gynaecol

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Considering the characteristics of low-grade endometrial stromal sarcoma (ESS), such as relative indolent course, younger age at diagnosis and favorable prognosis, the fertility-preserving management of low-grade ESS has been described by several authors. We report a 34-year-old female with stage IB low-grade ESS who developed recurrence 7 years after neoadjuvant high-dose progestin therapy followed by fertility-preserving surgery and postoperative progestin therapy. The patient stopped progestin therapy and was disease free for 4 years after diagnosis but experienced recurrence with peritoneal dissemination at 7 years. Considering the tendency of late recurrence, long-term surveillance is necessary to ensure timely action. Long-term progestin treatment might be considered after complete remission even beyond 5 years. We performed a literature review and found that many of the cases did not meet solid pathological criteria of low-grade ESS. The diagnostic criteria of low-grade ESS (vs endometrial stromal nodule) should be deliberately documented for future studies of this rare disease.

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Fertility-sparing management of low-grade endometrial stromal sarcoma: analysis of an institutional series and review of the literature

Cited by 28 publications

References 25 publications

BGCS uterine cancer guidelines: Recommendations for practice

BGCS uterine cancer guidelines: Recommendations for practice

Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma

Recurrence after fertility‐preserving surgery for low‐grade endometrial stromal sarcoma

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