Introduction/Background Standard treatment for endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) is total hysterectomy and bilateral salpingo-oophorectomy (BSO), however, young patients with early-stage EC and AEH in reproductive age often hope to preserve their fertility. The oncologic outcomes in long follow-up remain unclear especially regarding the incidences of recurrence or double cancer. We experienced two patients with EC who newly developed double cancer in their ovaries after medication of high-dose medroxyprogesterone acetate (MPA) for fertility-preservation.

Methodology In principle, we survey the patients after MPA therapy every four months using vaginal ultrasound check, endometrial histological/cytological examinations, measurement of serum CA125, and pelvic MRI once a year.

Results The 44 y/0 patient had received MPA therapy and cyclic surveillance every 4 to 6 months in the previous hospital, and she was introduced to our hospital with 3 year-recurrence-free interval. However, trans-vaginal (TV) echo showed solid tumor measuring 18 mm in diameter in the right ovary, and the serum CA125 was 32 U/ml. MRI revealed solid tumor with positive Gd-enhancement. Hysterectomy with RSO and LS were performed. Pathological examination revealed endometrioid carcinoma (EMC) G1 in uterus (pT1A), and mucin-producing EMC G1 in the right ovary (pT1A, primary ovarian cancer). Another 38 y/o patient had finished MPA therapy 4 months before. TV echo showed solid tumors measuring 30 mm in both ovaries, and the serum CA125 was 112 U/ml. MRI revealed solid tumors in both ovaries with positive Gd-enhancement. Hysterectomy with BSO, retroperitoneal lymphadenectomy was performed. Pathological examination revealed EMC G1 in uterus (pT1A), and mucin-producing EMC G2 in both ovaries (pT1B, bilateral primary ovarian cancers). Both patients have no recurrence after operation without adjuvant chemotherapy for 12 months.

Conclusion Strictly careful follow-up every 4 months using TV echo and CA125 is needed after fertility-preserving MPA therapy for detecting heterochronous overlapping cancers in ovaries.

Disclosure Nothing to disclose.