Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome

Thirty-nine patients with endometrioid adenocarcinoma (EA) and atypical hyp erplasia (AH) of the endometrium who received conservative treatment to pre serve fertility were collected from member institutions of the Japan Gyneco logic Oncology Study Group. Twenty-nine and ten were originally diagnosed w ith EA without myometrial invasion and AK, respectively. We performed a cen tral pathological review to make definite diagnoses, and the diagnosis of E A in 29 cases was changed to AH in ten, complex hyperplasia in three and at ypical polypoid adenomyoma in three, and AH in ten was changed to EA in one and simple hyperplasia in one. Nine of 12 women (75%) with EA and 15 of 18 women (83%) with AH had an initial response to medroxyprogesterone acetate (MPA) treatment. Two of nine responders with EA later developed relapse, a nd one of them had metastasis to the left obturator lymph node. Two became pregnant, and one delivered one full-term infant. One of the responders wit h AH had a relapse in the endometrium. Five became pregnant, and four deliv ered four normal infants. The young women with endometrial carcinoma locali zed in the endometrium who wish to preserve fertility may be treated as suc cessfully with MPA as those with AH. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.