title: Levonorgestrel-releasing intrauterine system alone as primary treatment in young women with early endometrial cancer: case report.
abstract: Young women with polycystic ovary syndrome (PCOS) are at increased risk of endometrial adenocarcinoma (EAC) through chronic unopposed estrogen production. We describe the first case, to our knowledge, of grade 1 endometrioid EAC arising in the context of complex atypical endometrial hyperplasia in a 26-year-old woman with thrombophilia and PCOS who wished to retain fertility potential and was treated using a levonorgestrel-releasing intrauterine system alone. At first follow-up biopsy, a single focus of complex hyperplasia without atypia was documented. All specimens sampled during subsequent follow-up demonstrated inactive endometrium with pseudodecidual changes, and no ultrasonographic or magnetic resonance (MR) images exhibiting myometrial invasion or endoabdominal spread were observed. This successful outcome suggests that insertion of a levonorgestrel-releasing intrauterine system is a treatment option in selected young women with early-stage EAC who are not candidates for systemic therapy and who wish to maintain fertility potential. Close histologic follow-up is required, and immediate surgery is mandatory if endometrial cancer persists.
authors.affiliation: Department of Gynecology, Perinatology, and Human Reproduction, University of Florence, Florence, Italy. maxfambrini@libero.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.forename: Gianni
authors.initials: G
authors.lastname: Bargelli
authors.forename: Elena
authors.initials: E
authors.lastname: Peruzzi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Buccoliero
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pieralli
authors.forename: Karin L
authors.initials: KL
authors.lastname: Andersson
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scarselli
authors.forename: Marcella
authors.initials: M
authors.lastname: Gallorini
authors.forename: Federica
authors.initials: F
authors.lastname: Zolfanelli
authors.forename: Mauro
authors.initials: M
authors.lastname: Marchionni
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000453:epidemiology; D000328:Adult; D015897:Comorbidity; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage*; D011085:Polycystic Ovary Syndrome / Q000453:epidemiology
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel