Fertility-sparing treatment for heterochronous primary ovarian and endometrial cancer that resulted in pregnancy and normal delivery: a case report

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  • 卵巣癌と子宮内膜癌の異時性重複癌に対して妊孕性温存療法後,妊娠・分娩に至った1例
  • 症例報告 卵巣癌と子宮内膜癌の異時性重複癌に対して妊孕性温存療法後,妊娠・分娩に至った1例
  • ショウレイ ホウコク ランソウ ガン ト シキュウ ナイマク ガン ノ イジセイ チョウフクガン ニ タイシテ ニンヨウセイ オンゾン リョウホウ ゴ,ニンシン ・ ブンベン ニ イタッタ 1レイ

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Abstract

The coexistence of ovarian and endometrial cancer in young women is not uncommon. We herein report a case of fertility-sparing treatment for heterochronous primary ovarian and endometrial malignant tumors that resulted in a pregnancy and normal delivery. A 33-year-old married nullipara was referred to our hospital for fertility-sparing treatment for endometrial cancer. Her older brother had died of leukemia at 16 years of age. When the patient was 28 years old, she was diagnosed with stage Ia endometrioid grade 2 adenocarcinoma of the ovary. She underwent six cycles of chemotherapy after left adnexectomy, right ovarian segmental resection, and pelvic lymphadenectomy at a previous hospital. She started infertility therapy immediately after completion of the chemotherapy, but she did not become pregnant. Four years and four months later, a cervical polyp was resected and pathological examination revealed an endometrioid Grade 1 adenocarcinoma. She strongly desired fertility preservation and was referred to our hospital. Myometrial invasion of tumor was not detected by magnetic resonance imaging, but dilatation and curettage revealed endometrioid Grade 1 adenocarcinoma. She underwent high-dose progesterone therapy for six months and achieved a pathological complete response. Two months later, she became pregnant with in vitro fertilization-embryo transfer and had a normal vaginal delivery at 38 weeks of gestation. She received Holmstrom therapy because of postpartum amenorrhea for one year and three months. There was no evidence of recurrence for two years and nine months after delivery. She desired another child, but we recommended that she receive standard therapy for the following reasons: 1) recurrence of endometrial cancer after delivery, recurrence of ovarian cancer, and new carcinogenesis of the opposite ovary are not rare; 2) a screening test for early detection of ovarian cancer has not been established. [Adv Obstet Gynecol, 68 (2) : 126-130, 2016 (H28.5)]

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