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Wepy C, Chapel DB, Mutter GL, Quade BJ, Nucci MR, Parra-Herran C. Localized Endometrial Proliferations of Pregnancy are Clonal Glandular Outgrowths Characterized by PTEN Loss and PIK3CA Pathogenic Variants. Mod Pathol 2023; 36:100213. [PMID: 37172903 DOI: 10.1016/j.modpat.2023.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/24/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Gestational endometrium can demonstrate a spectrum of atypical but benign changes. One such lesion is localized endometrial proliferation of pregnancy (LEPP), first described in a series of 11 cases. To understand its biological and clinical importance, we explore the pathologic, immunophenotypic, and molecular features of this entity. Nine cases of LEPP identified in 15 years were retrieved from departmental archives and reviewed. Immunohistochemistry and next-generation sequencing using a comprehensive 446-gene panel were performed when the material was available. Eight cases were identified in curettage specimens performed after first-trimester pregnancy loss, and 1 in the basal plate of a mature placenta. The mean patient age was 35 (range 27-41) years. The mean lesion size was 6.3 (range 2-12) mm. Architectural patterns, often coexisting in the same case, included cribriform (n = 7), solid (n = 5), villoglandular (n = 2), papillary (n = 2), and micropapillary (n = 1). Cytologic atypia was mild in 7 cases and moderate in 2. Mitotic activity was low (up to 3 per 2.4 mm2). All lesions were associated with neutrophils. Background Arias-Stella phenomenon was present in 4 cases. Immunohistochemistry was performed in 7 LEPP, all of which demonstrated wildtype p53, retained MSH6 and PMS2, membranous beta-catenin, and positive estrogen receptor (mean 71%) and progesterone receptor (mean 74%). All were negative for p40 except 1 case (focal weak positivity). PTEN was markedly reduced in background secretory glands in all cases; in 5/7, LEPP foci showed a complete absence of PTEN expression. PIK3CA pathogenic variants were identified in 4/4 cases sequenced; 3/4 had inactivating PTEN mutations. Follow-up, available in 8 patients (mean length = 51 months, range 7-161), was conservative with observation only and showed no persistence or adverse outcomes. LEPP is characterized by intraglandular cribriform/solid architecture, positive estrogen receptor/progesterone receptor, PTEN loss, and PIK3CA and PTEN mutations. Although our findings indicate that LEPP is neoplastic, for now, we advise against diagnosing LEPP as endometrial carcinoma or hyperplasia because LEPP has a particular clinicopathologic context (concurrent gestation), distinct morphology (purely intraepithelial complex growth), and indolent outcome. Thus, it should be distinguished from endometrial intraepithelial neoplasia and carcinoma for which therapeutic interventions are indicated.
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Affiliation(s)
- Cindy Wepy
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts; Eastern Connecticut Pathology Consultants, Manchester, Connecticut
| | - David B Chapel
- Department of Pathology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
| | - George L Mutter
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts
| | - Bradley J Quade
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts
| | - Carlos Parra-Herran
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts.
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W Adnan WF, Nik Mahmood NMZ, Ismail MP, Mohamad Zon E, Othman MS, Kamaludin Z. First-trimester miscarriage in the background of endometrial carcinoma. Cancer Treat Res Commun 2022; 33:100660. [PMID: 36455511 DOI: 10.1016/j.ctarc.2022.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endometrial cancer in young women (less than 40-year-old) is associated with anovulatory menses, polycystic ovarian syndrome (PCOS) and subfertility. Endometrial cancer occurring in a miscarriage is rare. We highlight a case of endometrial cancer occurring during miscarriage of a non-viable pregnancy, its management and the outcome. CASE A 32-year-old woman, Gravida 1 Para 0, was referred to our center at 7 weeks gestation in 2018 for uncontrolled diabetes mellitus diagnosed during investigation for subfertility. Her poor compliance with the treatment is consistent with an HbA1c of 8%. During the assessment, she was already complaining of lower abdominal pain. Ultrasound showed irregular IUGS with no fetal echo. She had a miscarriage soon; however, due to ultrasound evidence of thickened and irregular endometrium (17 mm) with mixed echogenicity, dilatation and curettage (D + C) were commenced. The first and second tissues were reported as the product of conception (POC) and well differentiated endometrioid adenocarcinoma, respectively. The first hysteroscopy showed foci area of polypoidal growth at the right posterior endometrium, obscuring the right ostium, with similar histology report. She was commenced on high-dose progestogen with hysteroscopy surveillance 6 months later, which showed disease regression. After two normal hysteroscopies and endometrial biopsies with continuous progestogen therapy for 12 months, cyclical progestogen for 12 months and follow-up for another 6 months, she had spontaneous conception and is currently pregnant at 16 weeks gestation. CONCLUSION Endometrial cancer should be suspected in high-risk patients with first-trimester miscarriage. Individualized treatment with high dose progestogen and follow-up with the proper patient and partner counselling and education has high successful regressionand later on, pregnancy rate.
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Affiliation(s)
- W Fadhlina W Adnan
- Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
| | - Nik Mohamed Zaki Nik Mahmood
- Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Pazudin Ismail
- Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Erinna Mohamad Zon
- Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Shukri Othman
- Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Zaleha Kamaludin
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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A Case of Undifferentiated Carcinoma in a 2-Month Postpartum Reproductive Tract with a Rapid and Fulminant Course. Case Rep Obstet Gynecol 2021; 2021:3516646. [PMID: 34712501 PMCID: PMC8548154 DOI: 10.1155/2021/3516646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Advanced carcinoma of the lower female reproductive tract is rare during pregnancy and the postpartum period. We here present a case of a 32-year-old Japanese woman, whose entire lower reproductive tract had been invaded by carcinomas as of 2 months after childbirth. She had been infertile, and pregnancy had been established by repeated embryo transfer. The gynecological cancer screening, which included Pap smear tests, was negative during the periods she underwent infertility treatment or during the first trimester. At 26 gestational weeks, the patient noticed uterine contractions concomitant with genital bleeding. Labor progressed slowly and steadily; thus, the pregnancy was ended by cesarean section at 29 weeks. At 2 months after childbirth, the patient experienced increased left abdominal pain and underwent a pelvic examination, revealing multiple pelvic masses and diffuse vaginal tumors causing stenosis. Vaginal tumors were biopsied, and histochemical analysis showed undifferentiated carcinoma with possible adenocarcinoma. Imaging modalities including CT, MRI, and PET-CT suggest that the carcinoma had invaded the entire reproductive tract, especially the uterine body, metastasized into the lungs and the ischial bones, and disseminated onto the peritoneum. She received multiple rounds of chemotherapy but died 6 months after childbirth. Taking into consideration the clinical feature and immunohistochemical profiles of the cancer cells, the endometrium is the most likely origin.
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Gaulin NB, Harinath L, Liang S, Krivak TC, Miller EM. Invasive endometrial adenocarcinoma and missed abortion: A case report. Gynecol Oncol Rep 2019; 31:100531. [PMID: 31989012 PMCID: PMC6970154 DOI: 10.1016/j.gore.2019.100531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022] Open
Abstract
Endometrial cancer has been diagnosed synchronous with missed abortion. Endometrial cancer treatment decisions depend on future reproductive desires. Fertility sparing hormonal therapy is effective for noninvasive endometrial cancer.
Background Endometrial cancer is the most common gynecologic cancer in the United States; however, reports of endometrial cancer diagnosed in the setting of intrauterine gestation are rare. Case We describe the case of a clinical stage IA grade 1 endometrioid endometrial adenocarcinoma diagnosed at the time of D&C performed for missed abortion in a gravida 1 para 0 female with no identifiable risk factors. Fertility-sparing treatment, with combined oral megestrol acetate and levonorgestrel intrauterine system, was used to manage this incidentally-diagnosed carcinoma with endometrial sampling every 3 months.
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Affiliation(s)
- Nicole B Gaulin
- Department of Obstetrics & Gynecology, West Penn Hospital/Allegheny Health Network, United States
| | - Lakshmi Harinath
- Department of Pathology, West Penn Hospital/Allegheny Health Network, United States
| | - Sharon Liang
- Department of Pathology, West Penn Hospital/Allegheny Health Network, United States
| | - Thomas C Krivak
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, West Penn Hospital/Allegheny Health Network, United States
| | - Eirwen M Miller
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, West Penn Hospital/Allegheny Health Network, United States
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Shiomi M, Matsuzaki S, Kobayashi E, Hara T, Nakagawa S, Takiuchi T, Mimura K, Ueda Y, Tomimatsu T, Kimura T. Endometrial carcinoma in a gravid uterus: a case report and literature review. BMC Pregnancy Childbirth 2019; 19:425. [PMID: 31747899 PMCID: PMC6864955 DOI: 10.1186/s12884-019-2489-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/04/2019] [Indexed: 02/08/2023] Open
Abstract
Background Endometrial carcinoma (EC) is rarely diagnosed during pregnancy. Therefore, the histopathological findings, clinical course, and gross appearance of the resected uterus during pregnancy are not well known. We present a case of EC diagnosed during pregnancy. In addition, we reviewed the literature dating from January 1995 to March 2019 for cases of EC diagnosed during pregnancy and within 15 months after pregnancy, and we discussed this topic to improve the understanding of this rare condition. Case presentation A 35-year-old woman underwent an urgent cesarean delivery in gestational week 35 due to antepartum bleeding caused by placenta previa. Hysterectomy was performed with the diagnosis of placenta accreta spectrum (PAS). Remarkably, the postoperative gross and histopathological examinations revealed an endometrioid adenocarcinoma (grade 1). The histopathological findings revealed a pattern similar to that of EC not related with pregnancy. Immunohistochemistry revealed an overexpression of the estrogen and progesterone receptors; however, the p53 expression was negative. We performed laparoscopic bilateral salpingo-oophorectomy and pelvic lymphadenectomy 102 days after the cesarean hysterectomy, and confirmed surgical stage IA without metastases. Our patient has had no recurrence in 4 years after the cesarean delivery. An electronic search of the literature revealed 25 cases of EC (including our case) diagnosed during or after pregnancy. Sixteen of the 25 patients were diagnosed after abortions in the first trimester, 9 were diagnosed within 14 months of childbirth, and our case was the first with diagnosis from a surgical specimen of peripartum hysterectomy due to the PAS. In 23 of the 25 cases endometrioid adenocarcinoma grade 1 to 2 was found, and it seemed to have a good prognosis. Conclusion The present findings suggest that careful examination of a resected uterus is essential, even when surgery is performed for an obstetric indication. Our case is an extremely rare case of EC during pregnancy; the histopathological pattern was similar to that of typical EC, and no recurrence was noted. The high levels of estrogen and progesterone during pregnancy did not seem to promote tumor progression in our case.
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Affiliation(s)
- Mayu Shiomi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeya Hara
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Nakagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Bayoglu Tekin Y, Guvendag Guven ES, Sehitoglu I, Guven S. Tubal pregnancy associated with endometrial carcinoma after in vitro fertilization attempts. Case Rep Obstet Gynecol 2014; 2014:481380. [PMID: 25614844 PMCID: PMC4295414 DOI: 10.1155/2014/481380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/11/2014] [Indexed: 01/04/2023] Open
Abstract
Endometrial carcinoma is rarely seen during reproductive ages and commonly related to infertility, polycystic ovarian syndrome (PCOS), and obesity. Pregnancy associated endometrial carcinoma is even rarer and this is the second case reported in the literature concerning tubal pregnancy associated endometrial carcinoma. We present a case of a 36-year-old woman with a history of PCOS, infertility, and several attempts of ovulation induction and in vitro fertilization, who was diagnosed with tubal pregnancy and a well differentiated endometrial carcinoma. We also review the literature about pregnancy associated endometrial carcinoma in the first trimester.
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Affiliation(s)
- Yesim Bayoglu Tekin
- Recep Tayyip Erdogan Universitesi, Tıp Fakultesi Dekanlığı, Islampaşa Mahallesi, Merkez, 53020 Rize, Turkey ; Department of Gynecology and Obstetrics, School of Medicine, Recep Tayyip Erdogan University, 53020 Rize, Turkey
| | - Emine Seda Guvendag Guven
- Department of Gynecology and Obstetrics, School of Medicine, Recep Tayyip Erdogan University, 53020 Rize, Turkey
| | - Ibrahim Sehitoglu
- Department of Pathology, School of Medicine, Recep Tayyip Erdogan University, 53020 Rize, Turkey
| | - Suleyman Guven
- Department of Gynecology and Obstetrics, School of Medicine, Black Sea Technical University, 61200 Trabzon, Turkey
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7
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Gynecologic malignancy in pregnancy. Obstet Gynecol Sci 2013; 56:289-300. [PMID: 24328018 PMCID: PMC3784125 DOI: 10.5468/ogs.2013.56.5.289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 12/20/2022] Open
Abstract
Gynecologic malignancy during pregnancy is a stressful problem. For the diagnosis and treatment of malignancy during pregnancy, a multidisciplinary approach is needed. Patients should be advised about the benefits and risk of treatment. When selecting a treatment for malignancy during pregnancy, the physiologic changes that occur with the pregnancy should be considered. Various diagnostic procedures that do not harm the fetus can be used. Laparoscopic surgery or laparotomy may be safely performed. The staging approach and treatment should be standard. Systemic chemotherapy during the first trimester should be delayed if possible. Radiation therapy should preferably start postpartum. Although delivery should be delayed preferably until after 35 weeks of gestation, termination of pregnancy may be considered when immediate treatment is required. Subsequent pregnancies do not increase the risk of malignancy recurrence.
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8
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Hoellen F, Reibke R, Hornemann K, Thill M, Luedders DW, Kelling K, Hornemann A, Bohlmann MK. Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies. Arch Gynecol Obstet 2011; 285:195-205. [PMID: 21858441 DOI: 10.1007/s00404-011-2058-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/02/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer in pregnancy is a rare circumstance. However, the coincidence of pregnancy and malignancy is supposed to increase due to a general tendency of postponing childbearing to older age. To date, clinical guidelines are scarce and experience regarding therapeutic management is limited to case reports. METHODS This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy. RESULTS In part I, we report on diagnosis and therapy of gynecological tumors. CONCLUSION The diagnosis of gestational cancer faces both oncologist and obstetrician to the dilemma of applying appropriate diagnostic techniques and adequate local and systemic therapy to an expectant mother without harming the fetus.
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Affiliation(s)
- Friederike Hoellen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Fadhlaoui A, Ben Hassouna J, Khrouf M, Zhioua F, Chaker A. Endometrial adenocarcinoma in a 27-year-old woman. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2010; 3:31-9. [PMID: 21769252 PMCID: PMC3046005 DOI: 10.4137/ccrep.s5346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Endometrial adenocarcinoma usually occurs after menopause, but in 2%-14% of cases, it occurs in young patients (less than 40 years of age) who are eager to preserve their fertility. Its treatment includes hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy, and, in some cases, radiation therapy. AIM To describe a case of endometrial adenocarcinoma occurring in a young woman and to undertake a literature review of risk factors and therapeutic options proposed for young women wishing to preserve their fertility. CASE We report a case of endometrial cancer in a 27-year-old woman treated for resistant menorrhagia and cared for in our department as well as in the Salah Azaiez Institute. CONCLUSION Endometrial adenocarcinoma rarely occurs in young women. In such cases, other therapeutic options can be proposed: progesterone therapy and LH-RH (Luteinzing-Hormone-Releasing-Hormone) agonists therapy in order to preserve fertility in younger patients.
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Affiliation(s)
- Anis Fadhlaoui
- Department of Obstetrics and Gynecology, Aziza Othmana University Hospital. Place du Gouvernement, La Kasba 1008 Tunis, Tunisia
- Medical University of Tunis, 15 Rue Djebel Lakhdhar, Bab Saadoun 1007, Tunis, Tunisia
| | - Jamel Ben Hassouna
- Department of Oncological Surgery, Salah Azaeiz Institute, Boulevard du 9 Avril, Bab Saadoun 1007 Tunis, Tunisia
- Medical University of Tunis, 15 Rue Djebel Lakhdhar, Bab Saadoun 1007, Tunis, Tunisia
| | - Mohamed Khrouf
- Department of Obstetrics and Gynecology, Aziza Othmana University Hospital. Place du Gouvernement, La Kasba 1008 Tunis, Tunisia
- Medical University of Tunis, 15 Rue Djebel Lakhdhar, Bab Saadoun 1007, Tunis, Tunisia
| | - Fethi Zhioua
- Department of Obstetrics and Gynecology, Aziza Othmana University Hospital. Place du Gouvernement, La Kasba 1008 Tunis, Tunisia
- Medical University of Tunis, 15 Rue Djebel Lakhdhar, Bab Saadoun 1007, Tunis, Tunisia
| | - Anis Chaker
- Department of Obstetrics and Gynecology, Aziza Othmana University Hospital. Place du Gouvernement, La Kasba 1008 Tunis, Tunisia
- Medical University of Tunis, 15 Rue Djebel Lakhdhar, Bab Saadoun 1007, Tunis, Tunisia
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Amant F, Brepoels L, Halaska MJ, Gziri MM, Van Calsteren K. Gynaecologic cancer complicating pregnancy: An overview. Best Pract Res Clin Obstet Gynaecol 2010; 24:61-79. [DOI: 10.1016/j.bpobgyn.2009.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 08/05/2009] [Indexed: 11/26/2022]
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Amant F, Van Calsteren K, Vergote I, Ottevanger N. Gynecologic oncology in pregnancy. Crit Rev Oncol Hematol 2008; 67:187-95. [PMID: 18296060 DOI: 10.1016/j.critrevonc.2008.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 01/16/2008] [Indexed: 11/19/2022] Open
Affiliation(s)
- Frédéric Amant
- Gynecologic Oncology, Leuven Cancer Institute (LKI), Department of Obstetrics and Gynecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
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13
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Rouzier R, Chauveaud A, Ancel PY, Brun JL, Mir O, Morice P, Frydman R, Treluyer JM, Uzan S. Structuration nationale pour la prise en charge des cancers en cours de grossesse : réseau CALG (cancers associés à la grossesse). ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0901-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- S Kehoe
- The Women's Centre, John Radcliffe Hospital, Headington, Oxford, UK
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15
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Abstract
PURPOSE OF REVIEW To review the management of gynaecological cancers occurring in association with pregnancy. To consider the impact of the cancer on the pregnancy, and the impact of the pregnancy on the cancer. RECENT FINDINGS The management of gynaecological cancers in pregnancy remains, fortunately, a rare problem for the gynaecological oncology team. This inevitably means that many management decisions will be informed by relatively small case series and case reports. There have been interesting reports where pregnancy has been prolonged to achieve fetal viability in both cervix and ovary cancer in pregnancy, and these are discussed below. SUMMARY Any cancer in pregnancy is a catastrophic event for the woman and her partner, and poses great challenges for the multidisciplinary team responsible for her care. Gynaecological cancers in pregnancy are even more stressful as the woman will naturally worry about the survival of her baby, and the implications for her future fertility. Fortunately the outcome for most women and their babies is favourable.
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Abstract
PURPOSE OF REVIEW Endometrial cancer can affect reproductive-age women who may desire fertility preservation. This article discusses the current, available data about conservative management of endometrial cancer in young women. RECENT FINDINGS Reproductive-age women with well differentiated endometrial carcinoma have an overall favorable prognosis provided that the tumor is identified at an early, noninvasive stage; however, advanced disease can be present. This article discusses current modalities to evaluate and clinically stage endometrial cancer including hysteroscopy, dilation and curettage, pelvic ultrasound, abdominopelvic computed tomography scan, pelvic magnetic resonance imaging, tumor marker CA125 level, and surgical exploration with laparoscopy or laparotomy. Thorough evaluation is critical as 10 to 29% of young women with endometrial cancer have a synchronous ovarian malignancy. Detailed counseling about the risks and benefits of conservative management, and expectations for fertility after treatment, surveillance, and definitive surgical management is essential. Multiple effective protocols exist for conservative treatment of endometrial cancer, and the initial response rates are as high as 57 to 75%. Successful pregnancies have occurred after conservative management, spontaneously, and with assisted reproductive technologies. SUMMARY There are no standard recommendations for selection of appropriate women, treatment protocols, or long-term surveillance for conservative management of clinical stage I endometrial adenocarcinoma, and larger prospective clinical studies are warranted.
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Affiliation(s)
- Beth W Rackow
- Division of Reproductive Endocrinology and Infertility, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
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Ferrandina G, Zannoni GF, Gallotta V, Foti E, Mancuso S, Scambia G. Progression of conservatively treated endometrial carcinoma after full term pregnancy: A case report. Gynecol Oncol 2005; 99:215-7. [PMID: 15979130 DOI: 10.1016/j.ygyno.2005.05.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 05/01/2005] [Accepted: 05/06/2005] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We describe a case of conservatively treated endometrial endometrioid (EE) adenocarcinoma which showed an aggressive clinical outcome after pregnancy. CASE A 30-year-old woman with a well differentiated EE adenocarcinoma decided to attempt a conservative approach and underwent progestin treatment with subsequent negative ultrasound and hysteroscopic controls. After 3 months, she conceived and at 36 weeks of gestation, a cesarean section was performed with multiple negative biopsies. Eight 8 months after delivery, an exploratory laparotomy documented disseminated poorly differentiated EE adenocarcinoma. Staging work up revealed diffuse metastatic disease. Despite chemotherapy, the patient experienced progression of disease with fatal acute respiratory syndrome due to massive neoplastic pulmonary lymphangitis. CONCLUSION Conservative medical management of endometrial cancer in young women willing to preserve their reproductive potential, carries on potential risks. Careful selection of cases, informed consent, and strict follow up procedures are mandatory.
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Affiliation(s)
- G Ferrandina
- Gynecologic Oncology Unit, Catholic University of Rome, Italy.
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Rubod C, Narducci F, Delattre C, Decocq J, Verbert A, Delahousse G. [Endometrioid adenocarcinoma arising from adenomyosis. A case report and literature review]. ACTA ACUST UNITED AC 2004; 33:140-4. [PMID: 15052180 DOI: 10.1016/s0368-2315(04)96413-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In spite of many references to carcinoma arising from endometriosis, there are few documented cases in the literature of endometrioid adenocarcinoma developed in association with adenomyosis. We report a case of endometrioid adenocarcinoma arising from adenomyosis. Carcinogenic and prognostic factors as well as the therapeutic consequences of this unusual situation are discussed. The use of hormonal replacement therapy by patients with a prior history of adenomyosis is also examined.
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Affiliation(s)
- C Rubod
- Clinique de Gynécologie Obstétrique et Néonatologie, Pavillon Paul Gellé, Centre Hospitalier de Roubaix, 91, avenue Julien-Lagache, 59100 Roubaix
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Itoh K, Shiozawa T, Shiohara S, Ashida T, Konishi I. Endometrial carcinoma in septate uterus detected 6 months after full-term delivery: case report and review of the literature. Gynecol Oncol 2004; 93:242-7. [PMID: 15047244 DOI: 10.1016/j.ygyno.2003.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endometrial carcinoma associated with pregnancy is rare. We present the case of a 39-year-old woman with endometrial carcinoma in the septate uterus detected 6 months after normal delivery. CASE The patient complained of vaginal bleeding from 32 weeks' gestation, and had a spontaneous vaginal delivery at 37 weeks. The bleeding continued after the delivery, but repeated endometrial cytology and biopsy did not reveal evidence of malignancy. An exploratory laparotomy was performed 6 months postpartum with suspicion of uterine myoma. A histological diagnosis of endometrial carcinoma was made based on examination of frozen sections from the hysterectomy specimen, and bilateral salpingo-oophorectomy and pelvic/para-aortic lymphadenectomy were also performed. Histological examination revealed G3 endometrioid adenocarcinoma with squamous differentiation, which arose in the septum of the uterus and deeply invaded the myometrium. The patient received postoperative chemotherapy and is healthy with no evidence of disease 3 years after the treatment. CONCLUSIONS Although pregnancy-associated endometrial carcinoma is rare, careful examinations are needed when unexplained vaginal bleeding continued.
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Affiliation(s)
- Kazuko Itoh
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
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21
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Abstract
Gynaecological malignancies frequently occur in women of reproductive age and are estimated to complicate approximately one in 1000 pregnancies. The incidence of gynaecological malignancies during pregnancy is expected to rise as more women delay childbearing into their later reproductive years, and maternal age is the most powerful predictor of cancer risk. Pregnancy-associated malignancies present significant challenges as a result of the conflict between optimal maternal therapy and fetal well-being. The lack of prospective randomised treatment studies has prevented the development of clinical guidelines for most of the issues complicating the management. In the present review, recent diagnostic and treatment strategies for cervical, ovarian, vulvar and endometrial carcinomas during pregnancy are presented.
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Affiliation(s)
- Martin K Oehler
- Department of Gynaecological Oncology, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia.
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Ichikawa Y, Takano K, Higa S, Tanabe M, Wada A, Sugita M, Tsunoda H, Nishida M. Endometrial carcinoma coexisting with pregnancy, presumed to derive from adenomyosis: a case report. Int J Gynecol Cancer 2001; 11:488-90. [PMID: 11906554 DOI: 10.1046/j.1525-1438.2001.01066.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Endometrial carcinoma coexisting with pregnancy is rarely observed. We report here the case of a 35-year-old woman with an endometrial carcinoma that was diagnosed 6 months after childbirth. Preoperative magnetic resonance imaging (MRI) revealed a cystic mass attached to the uterus, with a papillary projection on the wall of the mass. The patient underwent complete surgical extirpation and five postoperative courses of adjuvant chemotherapy, given that the tumor contents had leaked into the peritoneal cavity when the capsule of the tumor ruptured intraoperatively. Microscopic examination revealed an endometrioid adenocarcinoma in the muscular layer close to the uterine serosa that was presumed to derive from adenomyosis. Further investigation is required to elucidate the pathogenesis of endometrial carcinoma in association with pregnancy and adenomyosis.
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Affiliation(s)
- Y Ichikawa
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki 305-8575, Japan.
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23
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Abstract
A malignancy discovered in pregnancy is often difficult to manage; the optimal maternal therapy has to be balanced with the fetal well-being. Generally, the cancer is managed as though the patient is not pregnant. For the various site-specific cancers, surgery is the main modality of treatment; this should be individualized. Chemotherapeutic agents are highly teratogenic in the first trimester, with some adverse effects when used after 12 weeks' gestation. The overall survival rate for pregnancy-associated breast cancer is poor; the reasons for this are discussed. For cervical cancer, delivery by caesarean section appears to be the method of choice, with significantly better survival rates compared with those who deliver vaginally. Other gynaecological and non-gynaecological malignancies are discussed.
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Affiliation(s)
- V Sivanesaratnam
- Department of Obstetrics and Gynaecology, University of Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia.
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Ishioka S, Sagae S, Saito T, Sugimura M, Akutagawa N, Nishimura M, Ezaka Y, Kudo R. A case of uterine endometrial carcinoma 15 months post-partum. J Obstet Gynaecol Res 2000; 26:417-20. [PMID: 11152326 DOI: 10.1111/j.1447-0756.2000.tb01351.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A case of uterine endometrial carcinoma 15 months post-partum, who did have none of typical risk factors of uterine endometrial carcinoma, is presented. The occurrence of post-partum uterine endometrial carcinoma is extremely rare condition probably due to anti-carcinogenic effects of progesterone. Progesterone refractory cells in the uterine endometrium, which could be an origin of the endometrial carcinoma, might have existed.
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Affiliation(s)
- S Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University, Japan
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