Gurgan Timur, Bozdag Gurkan, Demirol Aygul, Ayhan Ali
Hacettepe University, School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
Reprod Biomed Online. 2007 Nov;15(5):561-5. doi: 10.1016/s1472-6483(10)60389-6.
Fertility-preserving treatment with progestin may be considered in nulliparous women with well-differentiated endometrial carcinoma. Recently, assisted reproductive treatments have been performed to achieve a rapid pregnancy in such cases. This report evaluates a 39-year-old woman who admitted with menorrhagia and primary infertility. Owing to persistent menstrual irregularity and thick endometrium, a diagnostic office hysteroscopy with endometrial biopsy was performed and revealed a well-differentiated adenocarcinoma. Although the woman wished to retain her childbearing potential with conservative management followed by an assisted reproduction cycle, the repeated endometrial biopsies during progestin treatment revealed persistent adenocarcinoma. Complementary surgery was performed due to persistent endometrial malignancy, which noted well-differentiated endometrioid adenocarcinoma without myometrial invasion or extrauterine disease. A review of cases with endometrial carcinoma that have been treated with conservative management and a subsequent assisted cycle is also presented here. To date, there are 14 such reports, including 15 women and 21 healthy infants. However, obtaining remission and maintaining the reproductive capability may not always be possible, even in early-stage cases. Therefore, patient and physician should always consider carefully if fertility-preserving management is preferred after diagnosis of endometrial carcinoma.
对于未生育且子宫内膜癌分化良好的女性，可考虑采用孕激素进行保留生育功能的治疗。近来，此类情况下已开展辅助生殖治疗以实现快速妊娠。本报告评估了一名39岁因月经过多和原发性不孕入院的女性。由于月经持续不规律且子宫内膜增厚，进行了诊断性宫腔镜检查及子宫内膜活检，结果显示为分化良好的腺癌。尽管该女性希望通过保守治疗并随后进行辅助生殖周期来保留生育潜力，但孕激素治疗期间反复的子宫内膜活检显示腺癌持续存在。因子宫内膜恶性病变持续存在而进行了补充手术，术中发现为分化良好的子宫内膜样腺癌，未侵犯肌层或有子宫外病变。本文还对采用保守治疗及随后辅助周期治疗的子宫内膜癌病例进行了综述。迄今为止，有14篇此类报告，包括15名女性和21名健康婴儿。然而，即使在早期病例中，也并非总能实现缓解并维持生殖能力。因此，患者和医生在诊断子宫内膜癌后决定是否首选保留生育功能的治疗时应始终谨慎考虑。
