Introduction/Background Endometrial cancer (EC) is a postmenopausal disease and occurs in only 4% of women 40 years and below.1Patients in this age group present with a low grade EC with excellent prognosis.2 Because of this age group, fertility sparing approach is a reasonable option for selected patients and must be tackled. This paper aims to share this unusual case in the medical field with the hope of being able to contribute with the establishment of a consensus on the management of EC in the young, that is fertility preserving.
Methodology KE is a 36 year old Gravida 0 with primary infertility, complaining of menorrhagia. She has a body mass index of 31.9 kg/m2. Ultrasound was done which showed thickened endometrium, hyperechoic with cystic spaces measuring 1.8 cm. Sampling was done which showed Endometrioid Adenocarcinoma. Abdominal CT scan showed a non enhancing unilocular, cystic mass measuring 3.5 x 2.5 cm, on the left ovary. No discrete uterine nor abdominopelvic mass, nor lymphadenopathy. She underwent Exploratory Laparotomy, Extrafascial Hysterectomy, with evaluation of lymph nodes. Her histopathology results confirmed diagnosis.
Results EC develops due to unopposed estrogen exposure. Risk factors include obesity, nulliparity, early menarche, polycystic ovarian syndrome, and sequential use of contraception.4 The standard treatment for EC is surgery. However, in some parts of the world, medical treatment is being applied with the most common regimen consisting of medroxyprogesterone acetate at 50 to 600 mg daily and megestrol acetate at 160 mg daily.1 Hormonal treatment has been shown to be successful in patients with a FIGO 1A staging.5 Factors to consider when doing conservative management include grade of disease, depth of myometrial invasion, presence of adnexal masses, and their future child bearing plans.3
Conclusion A consensus on a fertility sparing treatment should be made for young patients with EC.
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