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Histopathologic findings of the consecutive endometrial biopsies (H&E, ×110). First biopsy shows adenocarcinoma (A) arising in the atypical complex hyperplasia (B). (C) Second biopsy shows asynchronous endometrium with only focal atypical glands and degenerated morular lesions. (D) Third biopsy shows only asynchronous endometrium with atrophic glands. Fourth biopsy shows asynchronous endometrium (E) and pseudodecidualization (F).
Source publication
Endometrial cancer is the third most common gynecologic cancer in the Korea and occurs mainly in menopausal women. Although it can develop in young premenopausal women cancer as well, an attack in the adolescent girl is very rare. A 13-year-old girl visited gynecology department with the complaint of abnormal uterine bleeding. An endometrial biopsy...
Contexts in source publication
Context 1
... pathology, endometrial biopsy was performed with regional anesthesia. A histologic examination confirmed the endometrial adenocarcinoma arising in atypical complex hyperplasia that was well differentiated and grade II according to the FIGO (International Federation of Gynecology and Obstetrics) 2000 classification of endometrial cancer ( Fig. 2A, B) ...
Context 2
... the diagnosis of stage IA, grade II endometrial adenocarcinoma, megestrol acetate (megestrol acetate suspension; Daewon Pharmaceuticals, Seoul, Korea) was administrated with a dose of 160 mg daily for 3 months. A follow-up endometrial biopsy after the medication showed asynchronous endometrium with multifocal degenerated atypical glands (Fig. 2C). Treatment was continued with me- droxyprogesterone acetate (Provera, Pfizer Pharmaceuticals, New York, NY, USA) with a maintenance dose of 10 mg daily for 5 months, the second and third follow-up endometrial bi- opsy revealed asynchronous endometrium due to hormonal effect with no residual tumor (Fig. 2D-F). Follow-up magnetic ...
Context 3
... multifocal degenerated atypical glands (Fig. 2C). Treatment was continued with me- droxyprogesterone acetate (Provera, Pfizer Pharmaceuticals, New York, NY, USA) with a maintenance dose of 10 mg daily for 5 months, the second and third follow-up endometrial bi- opsy revealed asynchronous endometrium due to hormonal effect with no residual tumor (Fig. 2D-F). Follow-up magnetic resonance imaging also showed no endometrial mass or hy- perplasia. It has taken 8 months after medications till a com- plete remission. The patient made a gain of 14 kg in weight for the 8 months of medications. The weight gain was an only side effect of medical treatment and a source of anxiety, but it was ...
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Objectives
The diagnosis and treatment of cervical cancer during pregnancy is a challenge that requires a multi-disciplinary approach. The management depends on the gestational age at diagnosis, the stage of disease, the woman’s desire to continue the pregnancy and desire to preserve fertility. Neoadjuvant chemotherapy (NACT) is a treatment option...
Citations
... A study by Gallup and Stock (1984) found that 31% of patients presenting with Type I EC had associated PCOS [56]. One case report describes adenocarcinoma in a 13-year-old girl with a BMI of 24.8, who was found to have polycystic ovaries [57]. A review of 10 cases of endometrial carcinoma in women aged 15-25 found that 70% exhibited the characteristics of PCOS clinically, with three of them having polycystic ovaries on diagnosis [58]. ...
... There are gaps in the current literature and limitations to the outlined studies. While there are several case reports on adolescent females, very few data exist regarding EC in this population [57]. With the rise of the obesity epidemic in the pediatric population, it is imperative to recognize adolescent females who are at an increased risk of developing estrogen-driven EC earlier in life. ...
Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than Type II EC (80% vs. 20%) and is associated with a hyperestrogenic state. Estrogen unopposed by progesterone is considered to be the main driving factor in the pathogenesis of EC. Studies show that BMI > 30 kg/m², prolonged duration of menses, nulliparity, presence of polycystic ovarian syndrome, and Lynch syndrome are the most common causes of EC in premenopausal women. Currently, there are no guidelines established to indicate premenopausal patients who should be screened. This review aims to synthesize current data on the etiology, risk factors, presentation, evaluation, and prognosis of endometrial cancer in this population.
... The main characteristics of the included studies are summarized in Table 1. study was a prospective study [38], thirteen were retrospective studies [23,28,30-35,39 43,47], four were case series [37,[44][45][46], and four were case reports [29,36,40,48]. ...
... The main characteristics of the included studies are summarized in Table 1. One study was a prospective study [38], thirteen were retrospective studies [23,28,[30][31][32][33][34][35]39,[41][42][43]47], four were case series [37,[44][45][46], and four were case reports [29,36,40,48]. ...
... Of these, four studies were from Italy [30,38,43,44], five from Korea [23,33,36,39,42], three from China [32,46,47], three from the United States [29,40,41], two from Japan [34,35], two from Israel [31,48], one from France [37], one from Argentina [45], and one from Germany [28]. Andress et al. [28] 2021 Retrospective ...
Background: Endometrial cancer (EC) is the most common gynecological malignancy in both Europe and the USA. Approximately 3–5% of cases occur in women of reproductive age. Fertility-sparing treatment (FST) options are available, but very limited evidence regarding grade 2 (G2) ECs exists in the current literature. This systematic review aimed to comprehensively evaluate reproductive and oncologic outcomes among young women diagnosed with stage IA or G2EC disease who underwent FST. Methods: A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies that reported the oncologic and reproductive outcomes of patients with stage IA and G2EC tumors who underwent FST were considered eligible for inclusion in this systematic review (CRD42023484892). Studies describing only the FST for endometrial hyperplasia or G1 EC were excluded. Results: Twenty-two papers that met the abovementioned inclusion criteria were included in the present systematic review. Preliminary analysis suggested encouraging oncologic and reproductive outcomes after FST. Conclusions: The FST approach may represent a feasible and safe option for women of childbearing age diagnosed with G2EC. Despite these promising findings, cautious interpretation is warranted due to inherent limitations, including heterogeneity in study designs and potential biases. Further research with standardized methodologies and larger sample sizes is imperative for obtaining more robust conclusions.
... Thirty-seven articles were evaluated for eligibility after abstract screening. Finally, 23 studies were included in the systematic review [34][35][36][37][38][39][40][41][42][43][44][45]. ...
... Of the 23 articles included in this review, 12 were used to provide an overview of the conservative management of Stage 1A Grade (G) 2 EEC (FIGO) and the oncological and reproductive outcomes related; of these, 5 are retrospective observational studies [34][35][36][37][38], 4 case reports (one paper reporting 3 cases and another one reporting 2) [39][40][41][42], 1 a retrospective case series [43], 1 a prospective study [44], and 1 a multicenter retrospective cohort study [45]. The remaining analysis focused on immunohistochemical markers, although the data extrapolation was not easy due to the considerable heterogeneity of the studies published up to now. ...
... According to current published English papers, 84 patients with G2 stage IA took part in fertility-sparing treatment. The youngest patient was 13 years old as reported by Kim et al. [42], while the oldest was 85.2 years old by Pal et al. [43]. Pal et al. considered a wide age range, 18.5-85.2 ...
Background:
Endometrial cancer (EC) is one of the most common gynecologic malignancy, mostly in postmenopausal women. The gold standard treatment for EC is surgery, but in the early stages, it is possible to opt for conservative treatment. In the last decade, different clinical and pathological markers have been studied to identify women who respond to conservative treatment. A lot of immunohistochemical markers have been evaluated to predict response to progestin treatment, even if their usefulness is still unclear; the prognosis of this neoplasm depends on tumor stage, and a specific therapeutic protocol is set according to the stage of the disease.
Objective:
(1) To provide an overview of the conservative management of Stage 1A Grade (G) 2 endometrioid EC (FIGO) and the oncological and reproductive outcomes related; (2) to describe the molecular alterations before and after progestin therapy in patients undergoing conservative treatment.
Materials and methods:
A systematic computerized search of the literature was performed in the main electronic databases (MEDLINE, Embase, Web of Science, PubMed, and Cochrane Library), from 2010 to September 2021, in order to evaluate the oncological and reproductive outcomes in patients with G2 stage IA EC who ask for fertility-sparing treatment. The expression of several immunohistochemical markers was evaluated in pretreatment phase and during the follow-up in relation to response to hormonal therapy. Only scientific publications in English were included. The risk of bias assessment was performed. Review authors' judgments were categorized as "low risk," "high risk," or "unclear risk" of bias.
Results:
Twelve articles were included in the study: 7 observational studies and 5 case series/reports. Eighty-four patients who took progestins (megestrol acetate, medroxyprogesterone acetate, and/or levonorgestrel-releasing intrauterine devices) were analyzed. The publication bias analysis turned out to be "low." 54/84 patients had a complete response, 23/84 patients underwent radical surgery, and 20/84 had a relapse after conservative treatment. Twenty-two patients had a pregnancy. The length of follow-up was variable, from 6 to 142 months according to the different studies analyzed. Several clinical and pathological markers have been studied to identify women who do not respond to conservative treatment: PR and ER were the most studied predictive markers, in particular PR appeared as the most promising; MMR, SPAG9, Ki67, and Nrf2-survivin pathway provided good results with a significant association with a good response to progestin therapy. However, no reliable predictive markers are currently available to be used in clinical practice.
Conclusions:
The conservative treatment may be an option for patients with stage IA G2 EEC who desire to preserve their fertility. The immunohistochemical markers evaluation looks promising in predicting response to conservative treatment. Further large series and randomized clinical trials are needed to confirm these results.
... This situation is more important in young patients who wish to remain fertile. Since EC is seen even at a very young age, even as young as as 13 years, this is of concern in young patients with a desire to have children (32). The main treatment for EC is hysterectomy, but grade becomes the most important parameter in patients who desire fertility preservation and are considered to be stage 1A by imaging methods (33). ...
Objective: Studies on eosinophils have mostly been directed to parasitic infections and allergic diseases, but the role of eosinophils in oncology has been largely ignored. Eosinophils are an important modulator of the immune response and components of the inflammatory process against the tumor. This study was performed to investigate the pre-operative peripheral blood eosinophil percentages in patients with a histopathologically diagnosed pure endometrioid type endometrial carcinoma.
Material and Methods: Patients’ data were analyzed in two groups as present/absent according to whether there are tumor metastases in the adnexes, lymph nodes, cervical stroma, and whether there was lymphovascular space invasion. FIGO grade was taken as the basis of the tumor grade: Low-grade equated to grade 1 or 2, and high-grade equated to grade 3. The requirement for lymph node dissection was based on the Mayo criteria.
Results: The data of a total of 268 patients were included. The mean percentage of eosinophils in high-grade patients (n=29) was 2.75±0.35, and was significantly higher than the mean percentage of eosinophils of found in low-grade patients (n=239), which was 1.79±0.09 (p=0.013). Receiver operator curve analysis showed that a cut-off eosinophil percentage of 1.95% resulted in a sensitivity of 62% and specificity of 67% (p=0.004).
Conclusion: Eosinophil percentages, which are a simple, easily accessible, and inexpensive can be an important pre-operative predictive tool. Eosinophil percentages can be used in determining the need for surgical staging in endometrial cancer. (J Turk Ger Gynecol Assoc 2022; 23: 99-105)
... This situation is more important in young patients with fertility desire. Since EC is seen even at a very young age, such as 13, this is of concern in young patients with a desire to have children (32). The main treatment of EC is hysterectomy, but grade becomes the most important parameter in patients who desire fertility preservation and are considered to be stage 1A in imaging methods (33). ...
Objective:
Studies on eosinophils have mostly been directed to parasitic infections and allergic diseases, but the role of eosinophils in oncology has been largely ignored. Eosinophils are an important modulator of the immune response and components of the inflammatory process against the tumor. This study has been done to reveal the relationship between the data of 318 patients whose final pathology result was reported as a pure endometrioid type endometrial carcinoma (EC) and pre-operative peripheral blood eosinophil percentages.
Material and methods:
The data were analyzed in two groups as present/absent according to whether there are tumor metastases in the adnexes, lymph nodes, cervical stroma, and whether there is lymphovascular space invasion. FIGO grade was taken as basis in the evaluation of the tumor grade; Low-grade defines grade 1 or 2, and high-grade defines grade 3. The requirement for lymph node dissection was designed according to Mayo criteria. SPSS software program was used for statistical analysis.
Results:
The mean percentage of eosinophils in high-grade patients was 2.75 ± 0.35, and it was statistically significantly higher than the mean percentage of eosinophils of 1.79 ± 0.09 found in low-grade patients (p= 0.013). In the ROC analysis, when the cut-off eosinophil percentage was taken as 1.95%, the sensitivity was calculated as 62% and specificity as 67% (p= 0.004).
Conclusion:
Eosinophil percentages which are a simple, easily accessible, and inexpensive method can be an important pre-operative predictive tool. Eosinophil percentages can be used in determining the need for surgical staging in EC.
... It is difficult to provide precise estimations of the incidence of EC in the adolescent population because its occurrence in very young patients is exceedingly rare. However, the youngest patients reported in the literature were an 11-year-old [6] and a 13-year-old [7] girl. ...
... Figure 1 presents the flowchart for the identification of relevant literature sources. Fifteen studies were identified as fulfilling the inclusion and exclusion criteria [7,[11][12][13][41][42][43][44][45][46][47][48][49][50][51]. They presented 19 cases diagnosed with contemporary diagnostic criteria and described in sufficient or reasonably sufficient detail ( Table 1). ...
... Notably, in 12 (63.2%) patients Grade 1 EC was diagnosed [11,13,41,[44][45][46]49,51], in 5 (26.3%) patients Grade 2 (moderately differentiated) EC was diagnosed [7,42,43,48,50], and the diagnosis was not specified in 2 (10.5%) patients [12,47]. Endometrioid histology was ascribed to 16 (84.2%) ...
Although in developed countries endometrial cancer (EC) is the most common gynecological malignancy, its occurrence in adolescents is exceedingly rare. The increasing rate of obesity in children and adolescents is held responsible for the increasing prevalence of EC in younger cohorts of patients. The diagnosis of this malignancy can have devastating consequences for future fertility because standard treatment protocols for EC include hysterectomy. Here, we present the first detailed review of the world literature on EC in subjects aged 21 years or younger (n = 19). The mean age at diagnosis was 16.7 ± 0.6 years. One patient (5.3%) had a Type II (high-risk) disease. No communication retrieved from the search reported on patient death; however, two (10.5%) patients were lost to follow-up. There was also a high proportion (five subjects, or 26.3%) of cases with genetic background (Cowden syndrome and Turner syndrome), therefore genetic screening or a direct genetic study should be considered in very young patients with EC. The current fertility-sparing options, limited to Type I (low-risk) disease, are presented and discussed. Such information, obtained from studies on older women, translates well to adolescent girls and very young women. Careful anatomopathological monitoring at follow-up is essential for the safety of a conservative approach. Improved survival in very young EC patients makes the preservation of fertility a central survivorship issue, therefore both patients and caregivers should undergo counseling regarding available options. Moreover, our study suggests that genetic syndromes other than Lynch syndrome may be associated with EC more frequently than previously thought.
... For moderately differentiated (G2) tumors, data concerning the efficacy and safety of fertility-sparing treatment are very limited and do not allow to draw definitive conclusions on the conservative approach in this setting of patients. These data are mostly based on case reports and small retrospective series generally in the absence of long-term treatment outcomes [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. In general, G2 endometrioid ECs would seem less responsive to progestin therapy, with lower complete regression (CR) rates and longer times to CR than those observed in G1 cases [18,19]. ...
... To date, only 49 early-stage G2 endometrioid EC patients have been reported in the literature as having received fertility-sparing treatment, mostly from small institutional series except for one multicentric study ( Table 4) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Five of these patients [4,13] have been also included in the present study. ...
... The CR rate observed in our patients (73.9%) is very consistent with that extrapolated from the studies published so far (71.4%) ( Table 4) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Again, the median time to CR (6 months), the duration of CR (21 months), and the recurrence rate (41.1%) do not substantially differ from those reported for G2 EC so far ( Table 4). ...
Objective:
'The Endometrial Cancer Conservative Treatment (E.C.Co.). A multicentre archive' is a worldwide project endorsed by the Gynecologic Cancer Inter-Group, aimed at registering conservatively treated endometrial cancer (EC) patients. This paper reports the oncological and reproductive outcomes of intramucous, G2, endometrioid EC patients from this archive.
Methods:
Twenty-three patients (Stage IA, G2, endometrioid EC) were enrolled between January 2004 and March 2019. Primary and secondary endpoints were, respectively, complete regression (CR) and recurrence rates, and pregnancy and live birth rates.
Results:
A median follow-up of 35 months (9-148) was achieved. Hysteroscopic resection (HR) plus progestin was adopted in 74% (17/23) of cases. Seventeen patients showed CR (median time to CR, 6 months; 3-13). Among the 6 non-responders, one showed persistence and 5 progressed, all submitted to definitive surgery, with an unfavorauble outcome in one. The recurrence rate was 41.1%. Ten (58.8%) complete responders attempted to conceive, of whom 3 achieved at least one pregnancy with a live-birth. Two out of the 11 candidate patients underwent definitive surgery, while the remaining 9 have so far refused. To date, 22 patients show no evidence of disease, and one is still alive with disease.
Conclusions:
Fertility-sparing treatment seems to be feasible even in G2 EC, although caution should be kept considering the potential pathological undergrading or non-endometrioid histology misdiagnosis. The low rate of attempt to conceive and of compliance to definitive surgery underline the need for a 'global' counselling extended to the follow-up period.
... In the study by Thipgen et al. [61], the response rate were 37, 23 and 9% for G1, G2 or G3, respectively, suggesting that grading is one of the most important determinant to predict the outcome after progestin therapy. In spite of numerous data regarding the treatment of Stage IA G1, to date only four articles [19,38,69,70] described the management of stage IA, G2 EC in young patients (Table 1). Taking together the data from these papers, recurrence-free rate and survival rate were 100% (7/7). ...
Fertility-sparing surgery (FSS) in reproductive-age patients affected by endometrial cancer (EC) gained growing attention in the last decade, although the first reports were already published in 1990-2000s. Nevertheless, only few patients undergoing FSS for stage I, type I EC had been reported in each case series, without a robust multicenter study. In the available literature there are even fewer reported cases of conservative treatment of Stage IA and G2 EC. Considering these important gaps in our current knowledge, the purpose of this review was to summarize the available evidence about conservative treatments for stage IA type I and G2 EC, to improve the pretreatment counseling for reproductive-age patients. According to our overview, women who have low-risk disease (G1 or G2, endometrioid histotype confined to the endometrium) are candidates for progestin therapy. In addition, FSS could be considered a valid option for reproductive-aged patients with stage IA type I and G2 EC. Nevertheless, we solicit new trials to clarify the medium- and long-term outcomes in this kind of patients.
Background:
Endometrial cancer (EC) is the most common gynecological malignancy in both Europe and the USA. Approximately 3-5% of cases occur in women of reproductive age. Fertility-sparing treatment (FST) options are available, but very limited evidence regarding grade 2 (G2) ECs exists in the current literature. This systematic review aimed to comprehensively evaluate reproductive and oncologic outcomes among young women diagnosed with stage IA or G2EC disease who underwent FST.
Methods:
A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies that reported the oncologic and reproductive outcomes of patients with stage IA and G2EC tumors who underwent FST were considered eligible for inclusion in this systematic review (CRD42023484892). Studies describing only the FST for endometrial hyperplasia or G1 EC were excluded.
Results:
Twenty-two papers that met the abovementioned inclusion criteria were included in the present systematic review. Preliminary analysis suggested encouraging oncologic and reproductive outcomes after FST.
Conclusions:
The FST approach may represent a feasible and safe option for women of childbearing age diagnosed with G2EC. Despite these promising findings, cautious interpretation is warranted due to inherent limitations, including heterogeneity in study designs and potential biases. Further research with standardized methodologies and larger sample sizes is imperative for obtaining more robust conclusions.
Conclusions: Molecular classification could provide reliable supplementary information for evaluating prognostic and contribute to treatment option decision-making in EEC patients. Fertility-sparing treatment is not recommended for EEC patients with CNH and MSI-H. Furthermore, fertility-sparing treatment can be attempted in EEC patients with CHL, but regular follow-up should be carried out to early detection of EC relapse and prevention of disease progression.
