Case report: Spontaneous pregnancy after fertility-preserving treatment in a patient with low-grade endometrial stromal sarcoma (LGESS) and literature review

Xuezhen Luo^1,2*Manrong Wang^1,2Pengfei Wu^1,2Lulu Wang^1,2Sijia Liu³Qujia Gama^1,2Qiaoying Lv^1,2Jinyu Zhang^1,2Min Yu^1,2Yiqin Wang^1,2Fenghua Ma^1,2Weiwei Shan^1,2*

• ¹Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
• ²Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fudan University, Shanghai, Shanghai Municipality, China
• ³Fudan University, Shanghai, Shanghai Municipality, China

Introduction: Low-grade endometrial stromal sarcoma (LGESS) is a rare malignant tumor of the uterus, characterized by slow growth. Early-stage LGESS is associated with favorable survival, but it has a high recurrence rate. The primary treatment for this disease is full-staging surgery. In this report, we present a case to explore the potential for fertility-preserving treatment in young women with LGESS. Case presentation: A 29-year-old nulliparous patient diagnosed with stage IA LGESS underwent conservative treatment at the Obstetrics and Gynecology Hospital of Fudan University. After fertility-sparing surgery and three months of hormone treatment, no residual lesions were found. Subsequently, the patient conceived spontaneously and successfully delivered a healthy baby. However, she experienced recurrence eight months after delivery but declined hysterectomy and follow-up care. Conclusions: Currently, there is still no standard management protocol for fertility preservation therapy in LGESS. Both previously reported cases and our case suggest that fertility-sparing treatment may be an option for carefully selected patients with LGESS. Further research and larger clinical studies are necessary to explore fertility-preserving treatments for young nulliparous patients with LGESS to establish guidelines or consensus.