子宮鏡下手術により妊孕能温存療法を選択できた若年子宮体癌の2症例

抄録

Introduction: The incidence of endometrial cancer (EC) in women of reproductive age is increasing. Recently, the effectiveness of transcervical resection (TCR) for diagnosis and evaluation of therapeutic effects was demonstrated.

Case presentation: Case 1 was a 41-year-old woman who had undergone sterile treatment for years and was referred to a general hospital with complaints of increasing amount of menstruation. An endometrial biopsy and magnetic resonance imaging revealed that she had EC with an estimated stage of IB according to the International Federation of Gynecology and Obstetrics criteria. Although a laparotomy with total abdominal hysterectomy was recommended, the patient did not agree to the treatment option. She then visited our hospital for an alternative option and underwent TCR, which confirmed the diagnosis. Since deep myometrial invasion was restricted in TCR, a fertility-sparing treatment was performed. Case 2 was a 25-year-old woman who presented to a nearby hospital with atypical genital bleeding. Histological diagnosis based on an endometrial biopsy suggested endometrial carcinosarcoma. Although a hysterectomy was recommended, the patient did not agree to this treatment option. She was referred to our hospital, and she underwent TCR. The histological diagnosis was changed to endometrial adenocarcinoma G1 based on the biopsy obtained using TCR. A fertility-sparing treatment was performed, and complete remission was achieved.

Conclusion: Using TCR for diagnosis can drastically change the course of treatment in some cases. It is important to be prudent when diagnosing EC in young patients. Since TCR allows for the resection of only visible tumorous lesions and leaves the normal endometrium undamaged, it should be considered more often for patients with EC.