Fertility-Sparing Surgery in Young Women with Ovarian Anaplastic Carcinoma: Two Case Reports and Literature Review.

Background: Ovarian anaplastic carcinoma is rare, typically occurring in elderly women. Cases in young patients who desire fertility preservation are even rarer. More clinical data are required to guide evidence-based management strategies in this specific population. As the International Federation of Gynecology and Obstetrics staging system is the recognized standard for ovarian carcinoma staging, it is applied throughout this work. Methods: We report two cases of ovarian anaplastic carcinoma in young women (22 and 23 years old) admitted to our hospital, together with a review of five cases (including Case 2 in our report) previously published in patients who underwent fertility-sparing surgery. Results: The mean onset age of the patients who underwent fertility-sparing surgery was 22.8 years (range from 17 to 35 years). Except for one patient with stage IIIC disease who died of disease six months after undergoing fertility-sparing surgery, all other patients were diagnosed with stage IA disease. Among the stage IA patients who underwent FSS, two patients were disease-free at a median follow-up of 49.5 months, whereas two patients died of disease with overall survival of 120 and 44 months, respectively. Conclusion: Ovarian anaplastic carcinoma is a highly aggressive malignant epithelial tumor. Stage seems to be the key prognostic factor. Fertility-sparing surgery is exploratory in this rare disease without sufficient evidence of long-term oncologic safety and should be prudently considered only in carefully selected young patients. Molecular testing should be strongly considered whenever feasible to guide targeted therapy. Larger studies with long-term follow-up are needed to explore the safety of fertility-sparing surgery in this rare malignancy.