Development of metastatic endometrial endometrioid adenocarcinoma while on progestin therapy for endometrial hyperplasia

Jennifer M. Rubatt, Brian Slomovitz, Thomas W. Burke, Russell R. Broaddus

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background. Conservative treatment with progestins is a reasonable treatment option for endometrial complex atypical hyperplasia and, in the experimental setting, for some women with grade 1 endometrial endometrioid adenocarcinoma. The risk of progression to a high-stage endometrial cancer is quite low, with only two previously reported cases in the English literature. Case. A 40-year-old woman with endometrial complex atypical hyperplasia diagnosed by dilatation and curettage was managed conservatively with progestin therapy (initially, megesterol acetate; then, a combination oral contraceptive). More than 2 years after her original diagnosis, she developed endometrial endometrioid adenocarcinoma, FIGO grade 2, with lymph node metastasis. The tumor was microsatellite instability-high due to methylation of MLH1 and loss of MLH1 protein. Conclusion. Currently, there are no good criteria for predicting which patients with complex atypical hyperplasia/grade 1 endometrioid adenocarcinoma will optimally respond to progestin therapy. There is some evidence that endometrial complex hyperplasia demonstrating loss of MLH1 protein by immunohistochemistry is strongly related to subsequent or concurrent endometrial cancer, especially tumors of higher grade and stage. In a woman with a biopsy diagnosis of endometrial hyperplasia, evaluation of MLH1 protein status by immunohistochemistry may provide useful information when medical management is being considered.

Original languageEnglish (US)
Pages (from-to)472-476
Number of pages5
JournalGynecologic Oncology
Volume99
Issue number2
DOIs
StatePublished - Nov 2005
Externally publishedYes

Fingerprint

Endometrioid Carcinoma
Endometrial Hyperplasia
Progestins
Endometrial Neoplasms
Therapeutics
Immunohistochemistry
Literature
Dilatation and Curettage
Microsatellite Instability
Oral Contraceptives
Methylation
Hyperplasia
Neoplasms
Acetates
Lymph Nodes
Neoplasm Metastasis
Biopsy
MutL Protein Homolog 1

Keywords

  • Endometrial cancer
  • Endometrial hyperplasia
  • Microsatellite instability
  • MLH1
  • Progestin therapy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Development of metastatic endometrial endometrioid adenocarcinoma while on progestin therapy for endometrial hyperplasia. / Rubatt, Jennifer M.; Slomovitz, Brian; Burke, Thomas W.; Broaddus, Russell R.

In: Gynecologic Oncology, Vol. 99, No. 2, 11.2005, p. 472-476.

Research output: Contribution to journalArticle

Rubatt, Jennifer M. ; Slomovitz, Brian ; Burke, Thomas W. ; Broaddus, Russell R. / Development of metastatic endometrial endometrioid adenocarcinoma while on progestin therapy for endometrial hyperplasia. In: Gynecologic Oncology. 2005 ; Vol. 99, No. 2. pp. 472-476.
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