Case Report Progression of conservatively treated endometrial carcinoma after full term pregnancy: A case report G. Ferrandina a, * , G.F. Zannoni b , V. Gallotta a , E. Foti a , S. Mancuso c , G. Scambia d a Gynecologic Oncology Unit, Catholic University of Rome, Italy b Human Pathology, Catholic University of Rome, Italy c Department Obstetrics/Gynecology, Catholic University of Rome, Italy d Department of Oncology, Catholic University of Campobasso, Italy Received 10 March 2005 Available online 24 June 2005 Abstract Introduction. We describe a case of conservatively treated endometrial endometrioid (EE) adenocarcinoma which showed an aggressive clinical outcome after pregnancy. Case. A 30-year-old woman with a well differentiated EE adenocarcinoma decided to attempt a conservative approach and underwent progestin treatment with subsequent negative ultrasound and hysteroscopic controls. After 3 months, she conceived and at 36 weeks of gestation, a cesarean section was performed with multiple negative biopsies. Eight 8 months after delivery, an exploratory laparotomy documented disseminated poorly differentiated EE adenocarcinoma. Staging work up revealed diffuse metastatic disease. Despite chemotherapy, the patient experienced progression of disease with fatal acute respiratory syndrome due to massive neoplastic pulmonary lymphangitis. Conclusion. Conservative medical management of endometrial cancer in young women willing to preserve their reproductive potential, carries on potential risks. Careful selection of cases, informed consent, and strict follow up procedures are mandatory. D 2005 Elsevier Inc. All rights reserved. Keywords: Endometrial cancer; Pregnancy; Biological characterization Introduction Endometrial carcinoma is primarily a disease of post- menopausal women, although 2–14% of cases occurs in women less than 40 years who, very often, still desire pregnancy and need to preserve their reproductive function [1]. The association of pregnancy and endometrial cancer is rare as reported by Vaccarello et al. [2] in a large review of the literature, and in almost all cases of endometrial cancer arising in young women, histopathology reveals the presence of well differentiated endometrial endometrioid (EE) adenocarcinoma with at most superficial invasion, therefore endowed with a very favorable prognosis [3]. We describe a case of conservatively treated endometrial endometrioid adenocarcinoma which showed a very aggres- sive clinical outcome after an uneventful pregnancy. Case report A 30-year-old gravida 0 woman underwent D&C because of metrorrhagia associated with a history of uterine polyps. Her family and past history were unremarkable. Her gynecological history was negative with menarche at the age of 12 years and regular menses. D&C specimen resulted in a well differentiated endometrial endometrioid adenocar- cinoma with squamous differentiation (Fig. 1A). Ultrasound examination failed to document any signs of myometrial invasion. No imaging examinations were planned. 0090-8258/$ - see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2005.05.025 * Corresponding author. Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy. Fax: +39 06 35508736. E-mail address: gabriella.ferrandina@libero.it (G. Ferrandina). Gynecologic Oncology 99 (2005) 215 – 217 www.elsevier.com/locate/ygyno