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Fertility-Sparing Management of Grade 2 Endometrioid Endometrial Adenocarcinoma Without Progesterone Receptor
Luiz Felipe Lessa Ortiz1, Rafael Dyer Rodrigues de Moraes2, Renan Ribeiro E Ribeiro2
1Department of Reproductive Medicine and Oncofertility, GAVVA Clinic, Sao Paulo, Sao Paulo, Brazil.
Abstract:
Managing G2 endometrioid endometrial adenocarcinoma without progesterone receptor (PR) expression presents significant challenges, particularly when considering fertility preservation. Grade 2 tumors fall into an area of uncertainty within fertility-sparing strategies, making treatment decisions complex and requiring careful individualization. This case report describes a 41-year-old patient who, despite PR and PE negativity, responded to conservative management with hysteroscopic resection, a levonorgestrel-releasing intrauterine device, metformin, and later megestrol, achieving complete histological remission in 15 months. The difficulty in managing G2 tumors lies in their variable behavior, necessitating a multidisciplinary approach, strict monitoring, and adaptability based on treatment response. This case underscores that, although fertility preservation in PR-negative G2 tumors remains challenging, it is feasible in highly selected cases. The evolving literature suggests that alternative strategies, such as immune modulation and aromatase inhibitors, may further expand options. Individualized management remains crucial, balancing oncological safety with reproductive goals through continuous reassessment and engagement with emerging therapeutic evidence.
Insights
Managing progesterone receptor-negative G2 endometrioid endometrial adenocarcinoma for fertility preservation is challenging. This case shows successful conservative management in a selected patient, highlighting individualized treatment importance.
Area of Science:
- Gynecology
- Oncology
- Reproductive Medicine
Background:
- G2 endometrioid endometrial adenocarcinoma without progesterone receptor (PR) expression poses fertility preservation challenges.
- Grade 2 tumors represent an area of uncertainty in fertility-sparing strategies, demanding individualized treatment decisions.
Purpose of the Study:
- To describe a successful fertility-sparing management approach for a PR-negative G2 endometrioid endometrial adenocarcinoma case.
- To highlight the feasibility of conservative management in highly selected patients with challenging tumor characteristics.
Main Methods:
- Conservative management including hysteroscopic resection, levonorgestrel-releasing intrauterine device, metformin, and megestrol.
- Multidisciplinary approach with strict monitoring and adaptability based on treatment response.
Main Results:
- Complete histological remission achieved in 15 months in a 41-year-old patient with PR-negative G2 endometrioid endometrial adenocarcinoma.
- Demonstrated successful fertility preservation despite challenging tumor markers.
Conclusions:
- Fertility preservation in PR-negative G2 endometrioid endometrial adenocarcinoma is feasible in selected cases.
- Individualized management, balancing oncological safety and reproductive goals, is crucial.
- Emerging strategies like immune modulation and aromatase inhibitors may offer future options.
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