Ota Emi, Nomura Hidetaka, Omatsu Kohei, Takazawa Yutaka, Takeshima Nobuhiro
Department of Gynecology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Koto-ku, Ariake, Tokyo, 135-8550 Japan.
Division of Pathology, Toranomon Hospital, Tokyo, Japan.
Int Cancer Conf J. 2020 May 22;9(3):159-161. doi: 10.1007/s13691-020-00417-3. eCollection 2020 Jul.
Most endometrial carcinomas (ECs) occurring during pregnancy are diagnosed in the first trimester. During the gestation period, progesterone level, which has a protective effect on the endometrium, is found to increase. In EC cases, administering high-dose progesterone is a therapeutic strategy because this hormone can considerably shrink tumors. Herein, the case of a woman in whom EC progressed during pregnancy is reported. Before pregnancy, she was diagnosed with atypical polypoid adenomyoma based on a blind office biopsy. She spontaneously conceived 2 months later, although she was suggested to undergo dilatation and curettage under general anesthesia to confirm the diagnosis. Subsequently, fetal death occurred at 26 weeks. A vaginal delivery was deemed impossible due to vaginal metastasis of EC; thus, cesarean section was performed. Computed tomography revealed multiple lung, pelvic, and inguinal lymph node metastases. Additional biopsy demonstrated poorly differentiated endometrioid carcinoma. She underwent systemic chemotherapy. However, eventually, the disease progressed, resulting in death 11 months after the cesarean section. In the present case, grade 3 EC may have existed before pregnancy, and this condition could have been diagnosed if hysteroscopic resection or total curettage under general anesthesia was performed. Grade 1 tumor may have been eliminated by the high progesterone level maintained during pregnancy, and thus, only grade 3 tumor progressed. Women who wish to preserve their fertility should undergo precise whole endometrial examination. If not, the fetus and mother may consequently experience an eventful clinical course.
大多数妊娠期发生的子宫内膜癌（EC）在孕早期被诊断出来。在妊娠期，发现对子宫内膜有保护作用的孕酮水平会升高。在EC病例中，给予高剂量孕酮是一种治疗策略，因为这种激素可以显著缩小肿瘤。在此，报告一例妊娠期EC病情进展的女性病例。怀孕前，她基于门诊盲目活检被诊断为非典型息肉样腺肌瘤。尽管建议她在全身麻醉下进行刮宫术以确诊，但她在2个月后自然受孕。随后，胎儿在26周时死亡。由于EC发生阴道转移，无法进行阴道分娩；因此，实施了剖宫产。计算机断层扫描显示肺部、盆腔和腹股沟多处淋巴结转移。再次活检显示为低分化子宫内膜样癌。她接受了全身化疗。然而，最终病情进展，剖宫产11个月后死亡。在本病例中，3级EC可能在怀孕前就已存在，如果进行宫腔镜切除或全身麻醉下的全面刮宫术，这种情况本可以被诊断出来。1级肿瘤可能已被孕期维持的高孕酮水平消除，因此，只有3级肿瘤病情进展。希望保留生育能力的女性应接受精确的全子宫内膜检查。否则，胎儿和母亲可能会经历波折的临床过程。
