title: 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.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Conte
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Dalla Toffola
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Litta
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
keywords: disease recurrence; follow up; laparoscopic surgery; neoplasia; pregnancy; surgical management; young women