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Introduction: Endometrial polyps are a common cause of abnormal uterine bleeding. In some cases, premalignant or malignant lesions are identified within polyps in a biopsy or polypectomy specimen. Hysteroscopic polypectomy, a minimal invasive surgical procedure, has the added benefit of accurate pathologic diagnosis based on complete removal of the lesion. Herein we report two cases of successful treatment of stage Ia endometrial carcinoma pathologically-diagnosed by hysteroscopic polypectomy.
Case: Case 1: A 49-year-old patient was referred to our hospital for a cervical polypoid lesion protruding from the external cervical os with abnormal vaginal bleeding. Ultrasound and MRI revealed a pedunculated endometrial polyp-like mass in the uterine cavity occupying the cervical canal. The histologic diagnosis after hysteroscopic resection showed an endometrial carcinoma (G2) confined to a small portion of the base of the polypoid lesion, with the prominent portion being a benign polyp. She underwent a semi-radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. Case 2: A 37-year-old patient with a history of secondary infertility was referred to our hospital for selective chromotubation by hysterofiberscopy, in order to clarify the hysterosonographically-diagnosed left tubal obstruction. Hysterofiberscopic examination revealed a tiny polyp without abnormal vessels in the uterine cavity, which showed well-differentiated endometrial adenocarcinoma (G1) by hysteroscopic surgery. The patient was started on continuous oral medroxyprogesterone acetate (600 mg day for 6 months), and subsequently underwent laparoscopically-assisted myomectomy, followed by ovarian stimulation with clomiphene citrate. She gave delivered a male infant by cesarean section at 37 weeks gestation, weighing 2.3 kg.
