Fambrini Massimiliano, Bargelli Gianni, Peruzzi Elena, Buccoliero Anna Maria, Pieralli Annalisa, Andersson Karin L, Scarselli Gianfranco, Gallorini Marcella, Zolfanelli Federica, Marchionni Mauro
Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Florence, Italy.
J Minim Invasive Gynecol. 2009 Sep-Oct;16(5):630-3. doi: 10.1016/j.jmig.2009.05.007.
Young women with polycystic ovary syndrome (PCOS) are at increased risk of endometrial adenocarcinoma (EAC) through chronic unopposed estrogen production. We describe the first case, to our knowledge, of grade 1 endometrioid EAC arising in the context of complex atypical endometrial hyperplasia in a 26-year-old woman with thrombophilia and PCOS who wished to retain fertility potential and was treated using a levonorgestrel-releasing intrauterine system alone. At first follow-up biopsy, a single focus of complex hyperplasia without atypia was documented. All specimens sampled during subsequent follow-up demonstrated inactive endometrium with pseudodecidual changes, and no ultrasonographic or magnetic resonance (MR) images exhibiting myometrial invasion or endoabdominal spread were observed. This successful outcome suggests that insertion of a levonorgestrel-releasing intrauterine system is a treatment option in selected young women with early-stage EAC who are not candidates for systemic therapy and who wish to maintain fertility potential. Close histologic follow-up is required, and immediate surgery is mandatory if endometrial cancer persists.
患有多囊卵巢综合征（PCOS）的年轻女性由于长期无对抗的雌激素分泌，患子宫内膜腺癌（EAC）的风险增加。据我们所知，我们描述了首例1级子宫内膜样EAC，该病例发生在一名患有血栓形成倾向和PCOS的26岁女性的复杂性非典型子宫内膜增生背景下，该女性希望保留生育潜力，仅使用左炔诺孕酮宫内节育系统进行治疗。在首次随访活检时，记录到一个单一的无非典型性的复杂性增生灶。后续随访期间采集的所有标本均显示为具有假蜕膜样改变的静止子宫内膜，未观察到超声或磁共振（MR）图像显示有肌层浸润或腹腔内播散。这一成功结果表明，对于不适合进行全身治疗且希望维持生育潜力的早期EAC的特定年轻女性，插入左炔诺孕酮宫内节育系统是一种治疗选择。需要密切的组织学随访，如果子宫内膜癌持续存在，则必须立即进行手术。
