Aminimoghaddam Soheila, Abolghasem Nastaran, Jamshidnezhad Niousha
- Department of Gynecologic Oncology, School of Medicine, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Iran.
J Reprod Infertil. 2024 Apr-Jun;25(2):163-168. doi: 10.18502/jri.v25i2.16011.
Endometrial cancer represents the most prevalent malignant genital tract neoplasm in high-income countries and is the second most common cancer worldwide following cervical cancer. Endometriosis is a benign condition wherein endometrial glands and stroma are found outside the uterine cavity.
During a routine care and ultrasound examination of the uterus and adnexa of a 64-year-old woman, an increased endometrial thickness (22 ) was noted. In 2023, according to ultrasound report, the patient underwent diagnostic curettage with immunohistochemistry, revealing a pathological diagnosis of endometrial cancer (endometrioid adenocarcinoma) with positive staining for p16, estrogen receptor (ER), and vimentin. Subsequently, after one week, she underwent complete surgical staging. Extensive superficial endometriosis disseminated in the pelvis and vulva was noted during surgery and preoperative examinations. Final pathology confirmed a well-differentiated typical endometrioid carcinoma (grade 1) with 40% myometrial invasion and positive lymphovascular invasion. The patient was considered to be at stage 1A.
Despite some studies suggesting an unclear association between endometriosis and endometrioid or clear-cell ovarian cancers, the correlation between endometriosis and endometrial cancer and its prognosis remains ambiguous. Additionally, although infertility has been linked to both endometrial cancer and endometriosis in various studies, the presented case exhibited no signs of infertility. Extensive pelvic endometriosis with vulvar involvement was present, yet the patient did not exhibit any symptoms. This is in contrast to the typical initial manifestation of endometrial cancer, which is abnormal uterine bleeding. The patient's condition was incidentally detected through routine care due to an abnormal increase in endometrial thickness, prompting this presentation.
子宫内膜癌是高收入国家最常见的恶性生殖道肿瘤，是全球继宫颈癌之后第二常见的癌症。子宫内膜异位症是一种良性疾病，其特征是在子宫腔外发现子宫内膜腺体和间质。
在对一名64岁女性进行子宫和附件的常规检查及超声检查时，发现子宫内膜厚度增加（22 ）。2023年，根据超声报告，该患者接受了诊断性刮宫及免疫组化检查，病理诊断为子宫内膜癌（子宫内膜样腺癌），p16、雌激素受体（ER）和波形蛋白染色呈阳性。随后，一周后，她接受了完整的手术分期。手术和术前检查发现广泛的浅表性子宫内膜异位症扩散至盆腔和外阴。最终病理证实为高分化典型子宫内膜样癌（1级），肌层浸润40%，淋巴血管浸润阳性。该患者被认为处于1A期。
尽管一些研究表明子宫内膜异位症与子宫内膜样癌或透明细胞卵巢癌之间的关联尚不明确，但子宫内膜异位症与子宫内膜癌及其预后之间的相关性仍不明确。此外，尽管在各种研究中不孕与子宫内膜癌和子宫内膜异位症都有关联，但本病例未表现出不孕迹象。存在广泛的盆腔子宫内膜异位症并累及外阴，但患者未表现出任何症状。这与子宫内膜癌典型的初始表现——子宫异常出血形成对比。该患者的病情是由于子宫内膜厚度异常增加，在常规检查中偶然发现的，由此才有了本病例报告。
