title: Endometrioid adenocarcinoma after insertion of a levonorgestrel-releasing intrauterine system.
abstract: The levonorgestrel-releasing intrauterine system (IUS) is now widely used and recommended as a reliable contraceptive and treatment for menorrhagia. It also potentially provides a simple alternative to treatment for women with stage-1, grade-1 endometrial cancers who are at high risk for surgery. This case describes a 39-year-old multiparous patient who visited the gynecology outpatient department at a district general hospital with a history of heavy, prolonged periods for 1 year. Hysteroscopy and biopsy specimen revealed benign nonsecretory endometrium and a levonorgestrel-releasing IUS was inserted. The patient visited again 4 years later with an 8-month history of prolonged bleeding. Endometrial biopsy specimen confirmed well-differentiated endometrioid adenocarcinoma. This is the first case report, to our knowledge, where hysteroscopy was performed before levonorgestrel-releasing IUS insertion with conclusive evidence of initial negative malignancy followed by development of endometrial cancer 4 years after insertion. This case raises the question of the safety of levonorgestrel-releasing IUS for the prevention and treatment of endometrial hyperplasia and carcinoma.
authors.affiliation: Department of Obstetrics and Gynecology, Chase Farm Hospital, Enfield Middlesex, United Kingdom. rflemming@doctors.org.uk
authors.forename: Rhonda
authors.initials: R
authors.lastname: Flemming
authors.forename: Sahathevan
authors.initials: S
authors.lastname: Sathiyathasan
authors.forename: Anne
authors.initials: A
authors.lastname: Jackson
mesh_terms: D000328:Adult; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007434:Intrauterine Devices / Q000009:adverse effects*; D016912:Levonorgestrel / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008595:Menorrhagia / Q000517:prevention & control*; D010052:Ovariectomy; D012489:Salpingostomy
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel