子宮腺筋症に対する子宮内膜焼灼術後に発見された子宮体癌 ⅣB 期の一例

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Background: Endometrial ablation is a widely accepted conservative surgical approach for women with abnormal uterine bleeding. However, data on late-onset endometrial ablation failure are scarce. Endometrial cancer, particularly after endometrial ablation for adenomyosis, is unknown.

Case: A 53-year-old Japanese woman had microwave endometrial ablation for heavy menstrual bleeding caused by adenomyosis after excluding uterine malignancy. Prior ablation a hysterectomy was discussed because medical management had been unsuccessful. However, she elected to preserve the uterus and underwent a hysteroscopic endometrial resection and microwave endometrial ablation. Based on histopathological findings, initially, adenomyosis was diagnosed. Sixteen months after ablation, the patient presented with sudden-onset leg pain and was diagnosed with deep vein thrombosis (DVT), pulmonary embolism (PE), multiple brain infarctions, and enlargement of the uterus. As uterine malignancy was highly suspected, abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic/aortic lymphadenectomy were performed. Histopathological analysis revealed endometrioid endometrial carcinoma grade 1 with a clear cell carcinoma component. However, later diagnosis by computed tomography showed FIGO Stage IVB presenting with isolated supraclavicular lymph node metastases. We reviewed past pathological examinations, and found atypical endometrial hyperplasia in the hysteroscopic endometrial resection specimen. Chemotherapy with paclitaxel and carboplatin was administered, which showed complete remission for 7 years.

Conclusion: Endometriosis and adenomyosis are associated with an increased risk of endometrial cancer; however, endometrial cancer following endometrial ablation may be difficult to diagnose. Further studies with patient selection and long-term surveillance are necessary to determine the safety and efficacy of endometrial ablation.