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  • Title: Progression of conservatively treated endometrial complex atypical hyperplasia in a young woman: a case report.
    Author: Corrado G, Baiocco E, Carosi M, Vizza E.
    Journal: Fertil Steril; 2008 Nov; 90(5):2006.e5-8. PubMed ID: 18692828.
    Abstract:
    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. DESIGN: Case report. SETTING: Division of Gynecologic Oncology, National Cancer Institute "Regina Elena," Rome, Italy. PATIENT(S): A nulliparous 36-year-old woman with endometrial CAH who decided on a conservative approach. INTERVENTION(S): 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. MAIN OUTCOME MEASURE(S): Failure of the conservative therapy and progression of disease. RESULT(S): 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. CONCLUSION(S): 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.
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