Endometrial carcinoma in a gravid uterus

A report describes a case of a 35-year-old woman (gravida 2, para 1) who presented with placenta previa at gestational week 31. She had an unremarkable medical history, and her previous pregnancy was an uncomplicated, normal vaginal delivery at gestational week 38. Her current pregnancy was otherwise uncomplicated. She refused to experience abnormal genital bleeding before the current pregnancy. 

Cervical cytology performed during early pregnancy stood negative for intraepithelial lesions. Vaginal ultrasonography demonstrated total placenta previa and one lacuna. Magnetic resonance imaging (MRI) at gestational week 31 demonstrated total placenta previa and diminished myometrium between the placenta and bladder wall. These findings prompted the diagnosis of placenta accreta spectrum (PAS) and an emergency cesarean delivery was conducted due to antepartum bleeding (approximately 100 mL) at gestational week 35. A healthy male infant weighing 2274 g was delivered with Apgar scores of 8 and 9, at 1 and 5 min, respectively. However, the placenta did not deliver within 30 min after fetal delivery, thus mandating hysterectomy for PAS. Evaluated blood loss was 1000 mL. The postoperative course was uneventful, and the patient and baby were sent back home on the 8th postoperative day.

Some portion of the chorion and placenta remained adhered to the uterus. The resected uterus was split into 7 specimens for macroscopic and histopathological analyses. The surgical specimen revealed a white polyp measuring 2 cm, which parted from the uterine fundus and the lower uterine segment. Histopathological examination of the tumor affecting the lower uterine segment displayed endometrioid adenocarcinoma (Grade 1), with < 50% myometrial invasion and positive expression of estrogen and progesterone receptors, along with PAS. Interestingly, the tumor affecting the uterine fundus showed no myometrial invasion. Histopathological findings of tumors located in the uterine lower segment and uterine fundus were similar. 

A retrospective review of the MRI images obtained during pregnancy displayed the tumor involving the uterine fundus, however, involvement of the lower uterine segment was challenging to detect.

A laparoscopic bilateral salpingo-oophorectomy and pelvic lymphadenectomy, conducted 102 days after cesarean hysterectomy, confirmed the absence of metastases. The tumor was staged as an IA lesion based on the International Federation of Gynecology and Obstetrics system. 

Follow-up conducted after 4 years of cesarean hysterectomy showed no recurrence.

Source: Shiomi M, Matsuzaki S, Kobayashi E. et al. Endometrial carcinoma in a gravid uterus: a case report and literature review. BMC Pregnancy Childbirth. 2019;19(425). https://doi.org/10.1186/s12884-019-2489-y