Endometrioid adenocarcinoma after insertion of a levonorgestrel-releasing intrauterine system
Flemming, R.; Sathiyathasan, S.; Jackson, A.
Journal of Minimally Invasive Gynecology 15(6): 771-773
2008
ISSN/ISBN: 1553-4650 PMID: 18971148 DOI: 10.1016/j.jmig.2008.08.016Document Number: 204373
The levonorgestrel-releasing intrauterine system (IUS) is now widely used and recommended as a reliable contraceptive and treatment for menorrhagia. It also potentially provides a simple alternative to treatment for women with stage-1, grade-1 endometrial cancers who are at high risk for surgery. This case describes a 39-year-old multiparous patient who visited the gynecology outpatient department at a district general hospital with a history of heavy, prolonged periods for 1 year. Hysteroscopy and biopsy specimen revealed benign nonsecretory endometrium and a levonorgestrel-releasing IUS was inserted. The patient visited again 4 years later with an 8-month history of prolonged bleeding. Endometrial biopsy specimen confirmed well-differentiated endometrioid adenocarcinoma. This is the first case report, to our knowledge, where hysteroscopy was performed before levonorgestrel-releasing IUS insertion with conclusive evidence of initial negative malignancy followed by development of endometrial cancer 4 years after insertion. This case raises the question of the safety of levonorgestrel-releasing IUS for the prevention and treatment of endometrial hyperplasia and carcinoma.
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