2016 Volume 68 Issue 3 Pages 237-242
Endometrial carcinoma is the most common gynecological cancer. About 5.3% of women with endometrial cancer are under 40 years of age, and cancer incidence in young women is rising. Conservative progestin therapy is common for young women of childbearing potential. However, repeat conservative progestin therapy is not recommended for patients with cancer recurrence. We evaluated progesterone receptor (PgR) and estrogen receptor (ER) expression in a patient who received multiple courses of conservative progestin therapy for recurrence of endometrial carcinoma. The patient, a-39-year woman, gravida 1, parity 0 with primary infertility, with endometrial adenocarcinoma G1. She received conservative high-dose medroxyprogesterone acetate (MPA) therapy. However, she had a recurrence six months after initial therapy, and received a second course of MPA therapy, because of her desire to preserve childbearing potential. Eight months after the second course of therapy, she had another recurrence and required repeat MPA therapy. Three months after the third course of therapy, considering the lack of response, she finally underwent total laparoscopic hysterectomy. Immunohistochemical staining for PgR expression was positive, before initial therapy and the second and third courses. In contrast, PgR expression was negative after all three courses of therapy. ER expression was positive throughout all courses of therapy. These finding suggested that PgR-negative, treatment-resistant cells remain throughout all courses of therapy. Several studies of PgR expression before initial therapy have demonstrated usefulness in predicting response to conservative progestin therapy. However, little is known regarding PgR expression post-treatment and its relationship to response to repeat conservative progestin therapy. The presence of PgR expression throughout therapy may be useful information when patients have recurrence and require repeat conservative progestin therapy. [Adv Obstet Gynecol, 68 (3) : 237-242, 2016 (H28.8)]
