Endometrial cancer with tubal metastasis detected during laparoscopic surgery in a patient undergoing fertility-sparing treatment with medroxyprogesterone acetate: a case report and review of the literature

Abstract

Objectives: Medroxyprogesterone acetate (MPA) therapy is useful as a fertility-sparing treatment for early endometrial cancer, but it poses a risk of progression and recurrence during the treatment. We report a case of endometrial cancer with tubal metastases after long-term MPA therapy and review the literatures focusing on the failure of fertility-sparing treatment. Case: A nulliparous, 40 years old woman was started on MPA therapy after being diagnosed with grade 1 endometrioid carcinoma confined to the endometrium. She achieved complete remission after 10 months of treatment, but no pregnancy was established by assisted reproductive technology (ART). Eleven months after the first MPA therapy ended, atypical endometrial hyperplasia was confirmed. The disease was in remission again after the second MPA therapy for 8 months. The patient did not become pregnant by subsequent ART. Finally, a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. The gross pathological specimen revealed a 13 mm mass near the left uterine cornu. Histopathology showed a left tube metastasis. She was diagnosed with FIGO stage IIIA endometrial cancer and underwent the staging surgery by laparotomy. After the second surgery, adjuvant chemotherapy was initiated. After 13 months of disease-free survival, a recurrence was histologically detected at the vaginal stump. Following intracavitary radiation therapy, there was no evidence of disease for 10 months. Conclusions: The patient undergoing fertility-sparing treatment should be apprised of a risk of life-threatening progression of the disease. Once the patient has opted out of fertility preservation, definitive hysterectomy should be strongly recommended.