Progression of conservatively treated endometrial complex atypical hyperplasia in a young woman: a case report.
OBJECTIVE
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.


METHODS
Case report.


METHODS
Division of Gynecologic Oncology, National Cancer Institute "Regina Elena," Rome, Italy.


METHODS
A nulliparous 36-year-old woman with endometrial CAH who decided on a conservative approach.


METHODS
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.


METHODS
Failure of the conservative therapy and progression of disease.


RESULTS
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.


CONCLUSIONS
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.
Corrado
Giacomo
G
Division of Gynecologic Oncology, National Cancer Institute Regina Elena, Rome, Italy. giacomo.corrado@alice.it
Baiocco
Ermelinda
E
Carosi
Mariantonia
M
Vizza
Enrico
E
D000022:Abortion, Spontaneous; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D004714:Endometrial Hyperplasia / Q000473:pathology / Q000628:therapy*; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D010535:Laparoscopy; D019290:Megestrol Acetate / Q000627:therapeutic use*; D009367:Neoplasm Staging; D010052:Ovariectomy; D010062:Ovulation Induction; D011230:Precancerous Conditions / Q000473:pathology / Q000628:therapy*; D011247:Pregnancy; D018714:Radiotherapy, Adjuvant; D017211:Treatment Failure
D019290:Megestrol Acetate