Active surveillance of cervical intraepithelial neoplasia grade 2 (CIN2) is increasingly adopted to reduce the risk of overtreatment, particularly in young

Background: Epithelioid uterine leiomyoma is an uncommon histological variant and is exceptionally rare in adolescence. Its unusual anatomical presentation may complicate preoperative characterization, while definitive diagnosis relies on histopathological evaluation, including distinction from other uterine smooth muscle tumors such as smooth muscle tumors of uncertain malignant potential (STUMP). Case presentation: A 15-year-old adolescent presented with progressive dysmenorrhea and pelvic pain. Transabdominal ultrasound and pelvic magnetic resonance imaging revealed a solid infraligamentary uterine mass with imaging features predominantly suggestive of a benign leiomyoma. Given the persistence of symptoms, fertility-preserving laparoscopic myomectomy was performed. Histopathological and immunohistochemical examination demonstrated an epithelioid leiomyoma characterized by mild-to-moderate cytological atypia, very low mitotic activity (generally < 2 mitoses/10 high-power fields, with a maximum count of 2/10 HPF), absence of tumor necrosis, and a low proliferative index. Expert pathological review supported the diagnosis of epithelioid leiomyoma, while noting features close to the diagnostic boundary with STUMP and recommending close follow-up. At three-month short-term follow-up, the patient was asymptomatic, with no clinical or imaging evidence of recurrence; however, this interval is insufficient to assess long-term biological behavior or recurrence risk. Clinical relevance: This case highlights the diagnostic value of imaging–pathology correlation in an adolescent with an uncommon infraligamentary epithelioid uterine leiomyoma. Accurate histopathological characterization, including distinction from STUMP and other smooth muscle tumors, supports appropriate fertility-preserving management and informs individualized follow-up. Conclusion: Epithelioid uterine leiomyoma should be considered in the differential diagnosis of pelvic masses in adolescents, particularly when arising in an unusual anatomical location. Imaging–pathology correlation is essential for accurate characterization, while histopathological assessment provides definitive tumor classification. In this patient, fertility-preserving laparoscopic myomectomy was feasible and allowed complete lesion excision while preserving the uterus; this single case does not establish comparative effectiveness or long-term outcomes.

Background: Microinvasive cervical cancer represents the earliest stage of stromal invasion and is associated with excellent oncological outcomes. Its clinical relevance arises from the potential disproportion between the limited extent of invasive disease and the morbidity of radical treatment, particularly in young women wishing to preserve fertility. Increasing evidence supports a transition from stage-based surgical radicality toward individualized, risk-adapted management. This narrative review critically examines microinvasive cervical cancer as a distinct clinical model of therapeutic de-escalation, with particular attention to the boundaries between evidence-supported conservative treatment and areas in which uncertainty persists. Methods: A narrative review of PubMed/MEDLINE was conducted for studies published between January 2010 and March 2026. Evidence concerning FIGO stages IA1 and IA2 was analyzed, focusing on diagnostic conization, pathological risk factors, lymphovascular space invasion (LVSI), margin status, histological subtype, fertility-sparing treatment, sentinel lymph node (SLN) assessment, ultrastaging, and follow-up. Studies including broader early-stage cervical cancer populations were considered only when stage IA results were separately available or clinically transferable to microinvasive disease, and were interpreted as indirect evidence when appropriate. Results: Accurate conization represents the cornerstone of the diagnosis and initial risk stratification of microinvasive cervical cancer, providing essential information on depth of stromal invasion, margin status, LVSI, histological subtype and multifocality. However, optimal risk assessment should integrate pathological findings with clinical staging, appropriate imaging and, when indicated, nodal assessment. FIGO stage alone does not adequately define individual risk, while imaging itself cannot reliably exclude occult small-volume nodal disease; therefore, the relative contribution of pathology, imaging and surgical nodal staging should be tailored to the individual risk profile. In FIGO IA1 disease without LVSI and with negative margins, conization alone provides excellent oncological control and lymph node staging is generally unnecessary. LVSI should be considered a risk modifier that may influence nodal assessment rather than an automatic indication for more radical cervical surgery. In IA1 with LVSI and IA2 disease, SLN biopsy may provide nodal staging with lower morbidity than systematic lymphadenectomy, although evidence specifically generated in microinvasive tumors remains limited. Fertility-sparing treatment is oncologically appropriate in carefully selected patients, whereas simple hysterectomy represents an adequate definitive option after completion of reproductive plans. Microinvasive adenocarcinoma requires specific consideration because of its endocervical location, potential multifocality, and the biological distinction between HPV-associated and HPV-independent histotypes. Major uncertainties remain regarding the prognostic significance of LVSI and low-volume nodal disease, the optimal indications for SLN assessment, and the limits of exclusive conservative treatment in IA2 disease. Conclusions: Microinvasive cervical cancer should not be regarded simply as the earliest anatomical stage of cervical cancer, but as a distinct clinical setting in which diagnostic precision may enable oncologically safe therapeutic de-escalation. The available evidence supports a shift from maximum surgical radicality toward the minimum effective treatment, provided that accurate histopathological assessment, appropriate patient selection, and specialized follow-up are ensured. Importantly, several recommendations for stage IA—particularly for IA2 disease and nodal management—still rely partly on evidence extrapolated from broader early-stage cervical cancer populations. Prospective multicenter studies and dedicated stage IA registries are therefore needed to define more precisely the boundaries within which therapeutic de-escalation can be safely applied.