1010 l NOVEMBER JOGC NOVEMBRE 2014 CASE REPORT Key Words: Endometrial carcinoma, products of conception, abortion, fertility sparing Competing Interests: None declared Received on May 13, 2014 Accepted on August 6, 2014 Incidental Endometrial Carcinoma Diagnosed at First Trimester Pregnancy Loss: A Case Report Lana Saciragic, MD, 1,2 Christopher G. Ball, MBBS, MSc(Eng), 1,2 Shahidul Islam, MD, PhD, FRCPC, 1,2 Michael Fung-Kee-Fung, MBBS, FRCSC, MBA 1,2 1 University of Ottawa, Ottawa ON 2 The Ottawa Hospital, Ottawa ON Abstract Background: All cases reported to date of endometrioid endometrial adenocarcinoma (EEA) associated with pregnancy have been treated surgically or medically We describe a case of EEA in pregnancy that was managed expectantly, allowing for observation of the natural course of the disease Case: A 36-year-old woman, gravida 2 para 1, presented at eight weeks of pregnancy with heavy vaginal bleeding Ultrasound assessment confrmed a missed abortion, and the patient underwent dilatation and curettage Tissue pathology primarily suggested grade 1 EEA The patient chose expectant management Eight months later, she returned with vaginal bleeding Hysterectomy was performed and the hysterectomy specimen showed FIGO grade 1 stage 1A EEA Conclusion: Treating EEA associated with pregnancy is challenging Our experience in the case described here suggests that expectant management should not be undertaken due to a high risk of recurrence Résumé Contexte : Tous les cas signalés à ce jour d’adénocarcinome endométrial endométrioïde (AEE) associé à la grossesse ont fait l’objet d’une prise en charge chirurgicale ou médicale Nous décrivons un cas d’AEE pendant la grossesse ayant fait l’objet d’une prise en charge non interventionniste, ce qui a permis l’observation de l’évolution naturelle de la maladie Cas : Une femme de 36 ans, gravida 2 para 1, nous a consultés à huit semaines de grossesse en raison de saignements vaginaux abondants. L’évaluation échographique a confrmé la présence d’une rétention fœtale et la patiente a subi une dilatation-curetage. L’analyse pathologique des tissus a d’abord indiqué qu’il s’agissait probablement d’un AEE de grade 1 La patiente a alors choisi une prise en charge non interventionniste Huit mois plus tard, elle nous a consultés à nouveau en raison de ses saignements vaginaux Une hystérectomie a été menée et le spécimen d’hystérectomie indiquait la présence d’un AEE de stade 1A grade 1 FIGO Conclusion : La prise en charge de l’AEE associé à la grossesse est complexe Notre expérience dans le cas décrit aux présentes semble indiquer qu’une prise en charge non interventionniste ne devrait pas être mise en œuvre, en raison d’un risque élevé de récurrence J Obstet Gynaecol Can 2014;36(11):1010–1013 INTRODUCTION E ndometrioid endometrial adenocarcinoma (EEA) is the most common gynaecologic malignancy in the Western world. While the majority of cases are diagnosed during the postmenopausal years, 1 the incidence among women of child-bearing age appears to be rising, and is estimated to account for 5% to 30% of cases. 2 The youngest reported patient with EEA was a 14-year-old girl. 3 Identifying EEA within products of conception is exceedingly rare. Of the 35 such cases reported to date, 20 were diagnosed in the frst trimester of pregnancy and diagnosis was followed by surgical or medical treatment. 4 We report here the unique case of a woman with EEA identifed in the frst trimester, which was managed expectantly, allowing for observation of the natural history of the disease. THE CASE A 36-year-old woman, gravida 2 para 1, with an eight-week pregnancy according to last menstrual period presented with an episode of heavy vaginal bleeding. Ultrasound examination showed an intrauterine gestational sac of seven weeks’ size with no embryo. The patient’s BMI was 42 kg/m 2 . She had undergone a Caesarean section one year