Introduction <p>Alveolar soft part sarcoma (ASPS) is an exceptionally rare soft tissue malignancy, with limited data available on fertility preservation and pregnancy management. Managing ASPS during pregnancy poses unique challenges, particularly when the condition is incidentally discovered following surgery initially performed for presumed benign conditions.</p> Case presentation <p>We present the case of a young woman who underwent a transvaginal clamp procedure for a cervical myoma and a curettage due to irregular vaginal bleeding. Histopathological examination confirmed the presence of cervical ASPS. Shortly thereafter, an unexpected pregnancy was identified, prior to the completion of a comprehensive staging assessment and evaluation of residual lesions. The patient expressed a strong desire to continue the pregnancy. Under the guidance of a multidisciplinary team (MDT), she underwent close surveillance throughout her pregnancy. Histopathology revealed a low Ki-67 proliferation index, and a series of pelvic magnetic resonance imaging (MRI) scans showed no evidence of mass lesions. The patient successfully carried the pregnancy to term and delivered a healthy infant via cesarean section. During the cesarean section, a suspicious lesion was identified; however, biopsies and placental pathology confirmed the absence of residual tumor or metastasis. Follow-up at 42 days postpartum revealed no signs of tumor recurrence.</p> Conclusion <p>Our case provides valuable evidence supporting the safety of fertility preservation in patients with cervical ASPS in the short term. Additionally, we outline a management approach for pregnancies complicated by rare, low-grade malignancies through multidisciplinary evaluation. Our experience suggests that, with rigorous and dynamic evaluations, it may be possible for these patients to safely navigate pregnancy.</p>