Skip to main content

Table 1 A summary of the literature review findings for endometrioid carcinoma associated with pregnancy

From: Endometrial carcinoma in a gravid uterus: a case report and literature review

First authorYear (Reference number)Age (years)Timing of diagnosisOutocomePeriod after diagnosisSymptomsThe results of histopathogical examinationImmunohisotocheical stainingStageSurgical treatment
 Kovács AG1996 [5]35AbortionNANED1 yearAbnormal genital bleedingEA grade 1–2NAIABrachytherapy + TAH + BSO + RT
The authors hypothesized that pregnancy may adversely affect the tumor growth; however, it cannot be proven because of the limited number of cases.
 Kodama J1997 [6]30Postpartum7 monthsDOD8 monthsAbnormal genital bleedingPoorly differentiated adenosquamous carcinomaNAIIICC
The authors opined that an immature, progesterone-unresponsive endometrium could be the possible mechanism of allowing endometrial carcinoma to develop in pregnancy.
 Schammel DP1998 [7]38Abortion9 weeksNED58 monthsInfertilityEA grade 1NAIARepeat curettage with progesterone therapy
  41Abortion13 weeksNED48 monthsAbnormal genital bleedingEA grade 1NAIATAH + BSO
  29Abortion9–10 weeksNANANoneEA grade 1NAIANA
  34Abortion13 weeksNED12 monthsAbnormal genital bleedingEA grade 1NAIATAH + BSO
  33PostpartumDuring cesarean deliveryNED57 monthsNoneEA grade 1NAIARepeat curettage with progesterone therapy
The authors considered that the fate of the more advanced-stage tumors with deeper myometrial invasion or high-grade cytologic features may be less subject to the protective effects of gestational progesterone.
 Ayhan A1999 [8]44Abortion5 weeksNANAAbnormal genital bleedingEA grade 1NAIATAH + BSO + LND + OM
The authors cited a previous report which observed that hCG inhibits the DMBA-induced breast carcinogenesis in rats through an insulin-like growth factor-dependent mechanism.
 Foersterling DL1999 [9]31Postpartum9 weeksNED1 yearAbnormal genital bleedingEA grade 1NAIATAH + BSO
The authors opined that in pregnancy-associated endometrial carcinoma, part of the lining undergoes gestational change, whereas another part becomes neoplastic. The portion of the endometrium which becomes neoplastic may be sensitive to estrogen, yet unresponsive to progesterone.
 Vaccarello L1999 [10]35Abortion9 weeksNED31 monthsAbnormal genital bleedingEA grade 1NAIATAH + BSO
  40Postpartum4 monthsNED6 yearsAbnormal genital bleedingEA grade 1NAIATAH + BSO
  32Postpartum4 monthsNED3.5 yearsAbnormal genital bleedingEA grade 2NANATAH + BSO
They concluded that with concomitant secretory endometrium, the malignant regions must be progesterone refractory.
 Mitsushita J2000 [11]28Postpartum6 monthsNANAPrevious history of endometrioid carcinomaEA grade 1ER: positive
PR: positive
IATAH
The authors did not discuss the association between pregnancy and endometrioid carcinoma.
 Ishioka S2000 [12]25Postpartum14 monthsNED6 monthsAbnormal genital bleedingEA grade 1ER: positive
PR: negative
p53: negative
IAmRH + BSO + LND
The authors concluded that the occurrence of postpartum EC was extremely rare probably due to the anti-tumor effects of progesterone.
 Ichikawa Y2001 [13]35Postpartum6 monthsNED3.5 yearsLower abdominal painEA grade 1NAIBTAH + BSO + LND + OM + Appendectomy
The authors speculated that high progesterone levels during pregnancy may protect against EC.
 Itoh K2004 [14]39Postpartum6 monthsNED3 yearsAbnormal genital bleedingEA grade 1ER: negative
PR: negative
IBTAH + BSO + LND
The authors concluded that the anticancer effect of progesterone during pregnancy was in effect in these tumors.
 Hannuna KY2009 [3]34Abortion12 weeksNED18 monthsAbortionEA grade 1–2ER: positive
PR: positive
CK7: positive
CK20: negative
β-hCG: negative
E-cadherin: positive
EpCAM: positive
Placental alkaline phosphatase: positive
IAD&C
The authors speculated that the presence of EC might have been related to a hypoxic damage of the chorionic villi. It might suggest a causal correlation between endometrial malignancy and spontaneous abortion.
The authors found that most case reports of first trimester EA are also reported as arising in a focal lesion.
 Terada T2009 [15]29Concurrent endometrial adenocarcinoma and an early pregnancy lossNANAAbortionEA grade 2ER: positive
PR: positive
p53: positive
vimentin: positive
CA19–9: focal positive
CA125: positive
Ki-67: 80% labelling
CEA: negative
PTEN: negative
p16: negative
NARepeat curettage without progesterone therapy
The authors considered that EC associated with pregnancy were mostly in stages IA, and were histologically EAs.
 Akil A2012 [16]45Concurrent endometrial adenocarcinoma and an early pregnancy lossNANAAbortionEA grade 1NAIATAH + BSO + LND
The authors concluded that the routine histological examination of the curettage specimens for all first trimester abortions, independent of the age of the patient, should be encouraged.
 Saciragic L2014 [17]36Abortion8 weeksNANAAbnormal genital bleedingEA grade 1Ki67: positiveIATAH + BSO + LND
The authors discussed that in a woman with progesterone-resistant endometrium, development of endometrial carcinoma could be potentiated by the relatively hyperestrogenic environment of early pregnancy and subsequently allowed to proliferate further due to a lack of response to progesterone.
 Bayoglu Tekin Y2014 [18]36Abortion or ectopic pregnancyNANED1 yearEctopic pregnancyEA grade 1NANACurettage with progesterone therapy
The authors though that the presence of EC might have been related to the damage of the chorionic villi, suggesting a causal correlation between EC and spontaneous abortions.
 Zhou F2015 [19]40Concurrent endometrial adenocarcinoma and an early pregnancy lossNANAAbortionEA grade 1ER: positive
PR: positive
p53: negative
NARepeat curettage without progesterone therapy
  33Concurrent endometrial adenocarcinoma and an early pregnancy lossNANAAbortionEA grade 1ER: positive
PR: positive
p53: negative
NARepeat curettage without progesterone therapy
The authors considered that the careful histological examination of the curettage specimens for all first trimester pregnancy losses should be encouraged.
 Rizzuto I2019 [20]29Pregnancy of 7 weeks gestationNANED8 yearsAbnormal genital bleedingEANANASerial endometrial biopsy with insertion of a Levonorgestrel intrauterine device
Conservative management for EC in young women is possible including a case with an incidental diagnosis in pregnancy.
 Our case201935Placenta accreta spectrumCesarean hysterectomyNED4 yearsNoneEA grade 1ER: positive
PR: positive
p53: negative
IACesarean hysterectomy
Laparoscopic BSO + LND
  1. List of abbreviations: BSO Bilateral salpingo-oophorectomy, C Chemotherapy, CK7 Cytokeratin 7, CK20 Cytokeratin 20, CA19–9 Cancer antigen 19–9, CA125 Cancer antigen 125, CEA Carcinoembryonic antigen, D&C Dilatation and curettage, DOD Dead of disease, EA EA, EC endometrioid carcinoma, EpCAM Epithelial cell adhesion molecule, ER Estrogen receptor, β-hCG Human chorionic gonadotropin β-subunit, LND Lymph node dissection, mRH Modified radical hysterectomy, NA Not available, NED No evidence of disease, OM Omentectomy, PR Progesterone receptor, RT Radiation therapy, TAH Transabdominal hysterectomy