Corrado Giacomo, Baiocco Ermelinda, Carosi Mariantonia, Vizza Enrico
Division of Gynecologic Oncology, National Cancer Institute Regina Elena, Rome, Italy.
Fertil Steril. 2008 Nov;90(5):2006.e5-8. doi: 10.1016/j.fertnstert.2008.06.014. Epub 2008 Aug 9.
To describe a case of progression of endometrial complex atypical hyperplasia (CAH) to extrauterine endometrioid adenocarcinoma in a patient who had requested fertility-sparing management.
Case report.
Division of Gynecologic Oncology, National Cancer Institute "Regina Elena," Rome, Italy.
PATIENT(S): A nulliparous 36-year-old woman with endometrial CAH who decided on a conservative approach.
INTERVENTION(S): Conservative hysteroscopic resection of the lesion, the surrounding endometrium, and underlying myometrium plus hormone therapy regimen of megestrol acetate (160 mg) daily for 6 months.
MAIN OUTCOME MEASURE(S): Failure of the conservative therapy and progression of disease.
RESULT(S): Eighteen months after fertility-sparing management, a laparoscopic operation revealed grade 2 endometrium adenocarcinoma with superficial myometrial invasion and a microscopic metastasis of the left ovary and Douglas peritoneum. The patient underwent adjuvant chemotherapy followed by external beam radiation of the pelvis and brachytherapy. Twenty-five months after, she was free of disease.
CONCLUSION(S): Conservative therapy is feasible in carefully selected young women with endometrial CAH. However, close follow-up is required because of possible progression to endometrial cancer.
描述一例要求保留生育功能治疗的患者，其子宫内膜复杂性非典型增生（CAH）进展为子宫外子宫内膜样腺癌的病例。
病例报告。
意大利罗马国家癌症研究所“雷吉娜·埃琳娜”妇科肿瘤学部。
一名36岁未生育的患有子宫内膜CAH的女性，决定采用保守治疗方法。
通过宫腔镜对病变、周围子宫内膜及下方肌层进行保守性切除，外加醋酸甲地孕酮（160毫克）每日激素治疗方案，持续6个月。
保守治疗失败及疾病进展。
保留生育功能治疗18个月后，腹腔镜手术显示为2级子宫内膜腺癌，伴有浅肌层浸润以及左卵巢和Douglas腹膜的微小转移。患者接受了辅助化疗，随后进行盆腔外照射和近距离放疗。25个月后，她疾病无进展。
对于精心挑选的患有子宫内膜CAH的年轻女性，保守治疗是可行的。然而，由于可能进展为子宫内膜癌，需要密切随访。
