Development of localized cul-de-sac endometrioid carcinoma associated with deep infiltrating endometriosis during remission of early endometrial cancer
In: Gynecologic Oncology Reports, Jg. 31 (2020-02-01), S. 100526-100526
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Zugriff:
Deep infiltrating endometriosis (DIE) is a type of extraovarian endometriosis, which may cause pain-related symptoms of endometriosis, including dysmenorrhea, dyspareunia, and chronic pelvic pain, which may compromise the quality of life of women. Sites of occurrence include the rectovaginal septum, uterosacral ligaments, and utero-ovarian ligaments (Gordts et al., 2017). Malignant transformation occurs in approximately 1% of women with endometriosis and occurs in ovarian endometriomas, where it is called endometriosis-associated ovarian cancer (EAOC). Cases of malignant transformation of DIE have been reported, but the precise prevalence is unclear. Histologically, most EAOCs are endometrioid and clear cell carcinomas (Steed et al., 2004); therefore, DIE-associated cancer may have the same histology. Fertility-sparing treatment using high dose progestins such as medroxyprogesterone acetate (MPA) becomes increasingly relevant for patients with endometrial cancer who desire fertility. A previous meta-analysis of fertility-sparing treatments for patients with endometrial cancer revealed that the majority of patients achieve an initial remission. However, the recurrence rate is high (Wei et al., 2017). Repeated treatment is effective for intrauterine recurrences after initial treatment because most relapses are localized in the endometrium. Conversely, distant metastasis and/or extrauterine recurrence without local relapse is extremely rare. We report a case of endometrioid carcinoma arising from malignant transformation of DIE localized in the cul-de-sac in a patient with endometrial cancer who was in remission following fertility-sparing treatment. Case A 38-year-old nulliparous woman (height: 158 cm, weight: 48.0 kg, and body mass index: 19.2) was referred to our facility for examination of an endometrial polyp and uterine fibroids. An endometrial biopsy revealed endometrioid carcinoma, which was classified as grade 1 according to the International Federation of Gynecology and Obstetrics (FIGO) classification system, arising from the endometrium. Slight invasion of the myometrium was suspected based on magnetic resonance imaging (MRI), and thus we diagnosed as FIGO Stage IA endometrial cancer and uterine fibroids. The indication of fertility-sparing treatment for early endometrial cancer is limited to grade 1 endometrioid carcinoma without myometrial invasion (Rodolakis et al., 2015); therefore, this case was an exception; the patient had expressed a strong desire to preserve the uterus for future fertility, and was aware that it meant an increased risk of recurrence. Thus, we administered conservative hormonal treatment after receiving an informed consent from the patient. We administered 400 mg oral MPA and 2250 mg of metformin daily for six months, and she achieved remission. Transvaginal ultrasound and endometrial biopsy were performed at two-to-three-month intervals to identify any local recurrence during the follow-up period. After remission, she received fertility treatment, including three instances of ovarian stimulation and transvaginal oocyte retrieval, followed by in vitro fertilization – embryo transfer (IVF-ET) without success. Twenty months after the initial remission, we identified local recurrence in the endometrium. She received daily oral MPA and metformin for further six months, and remission was achieved again. She then conceived with cryopreserved embryo transfer 8 months after the second remission, but spontaneously miscarried.
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Development of localized cul-de-sac endometrioid carcinoma associated with deep infiltrating endometriosis during remission of early endometrial cancer
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Autor/in / Beteiligte Person: | Seki, Kumiko ; Hashimoto, Rei ; Mitsuhashi, Akira ; Ikeda, Jun-ichiro ; Ishikawa, Hiroshi ; Shozu, Makio |
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Zeitschrift: | Gynecologic Oncology Reports, Jg. 31 (2020-02-01), S. 100526-100526 |
Veröffentlichung: | Elsevier BV, 2020 |
Medientyp: | unknown |
ISSN: | 2352-5789 (print) |
DOI: | 10.1016/j.gore.2019.100526 |
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