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CASE REPORT Open Access
Endometrial carcinoma in a gravid uterus: acase report and literature reviewMayu Shiomi, Shinya Matsuzaki* , Eiji Kobayashi, Takeya Hara, Satoshi Nakagawa, Tsuyoshi Takiuchi,Kazuya Mimura, Yutaka Ueda, Takuji Tomimatsu and Tadashi Kimura
Abstract
Background: Endometrial carcinoma (EC) is rarely diagnosed during pregnancy. Therefore, the histopathologicalfindings, clinical course, and gross appearance of the resected uterus during pregnancy are not well known. Wepresent a case of EC diagnosed during pregnancy. In addition, we reviewed the literature dating from January 1995to March 2019 for cases of EC diagnosed during pregnancy and within 15months after pregnancy, and we discussedthis topic to improve the understanding of this rare condition.
Case presentation: A 35-year-old woman underwent an urgent cesarean delivery in gestational week 35 due toantepartum bleeding caused by placenta previa. Hysterectomy was performed with the diagnosis of placenta accretaspectrum (PAS). Remarkably, the postoperative gross and histopathological examinations revealed an endometrioidadenocarcinoma (grade 1). The histopathological findings revealed a pattern similar to that of EC not related withpregnancy. Immunohistochemistry revealed an overexpression of the estrogen and progesterone receptors; however,the p53 expression was negative. We performed laparoscopic bilateral salpingo-oophorectomy and pelviclymphadenectomy 102 days after the cesarean hysterectomy, and confirmed surgical stage IA without metastases. Ourpatient has had no recurrence in 4 years after the cesarean delivery.An electronic search of the literature revealed 25 cases of EC (including our case) diagnosed during or after pregnancy.Sixteen of the 25 patients were diagnosed after abortions in the first trimester, 9 were diagnosed within 14months ofchildbirth, and our case was the first with diagnosis from a surgical specimen of peripartum hysterectomy due to thePAS. In 23 of the 25 cases endometrioid adenocarcinoma grade 1 to 2 was found, and it seemed to have a goodprognosis.
Conclusion: The present findings suggest that careful examination of a resected uterus is essential, even when surgeryis performed for an obstetric indication. Our case is an extremely rare case of EC during pregnancy; the histopathologicalpattern was similar to that of typical EC, and no recurrence was noted. The high levels of estrogen and progesteroneduring pregnancy did not seem to promote tumor progression in our case.
Keywords: Placenta accreta spectrum, Placenta previa, Pregnancy, Endometrioid carcinoma endometrial carcinoma,Endometrial cancer
This study presents a case of endometrioid carcinomadiagnosed during pregnancy. We performed literaturereview and discussed this topic. We have discussed theeffects of pregnancy on endometrioid carcinoma in aprevious study. Our present study found the points listedbelow.
1. Although endometrial carcinoma during pregnancyis extremely rare, careful observation of the resecteduterus is needed to avoid a missed diagnosis.
2. In our case, histopathological andimmunohistochemical findings were consistent withendometrioid adenocarcinoma grade 1. The patienthas been disease-free for about 4 years aftercesarean hysterectomy. The high levels of estrogenand progesterone during pregnancy did not seem topromote tumor progression in our case.
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
* Correspondence: [email protected] of Obstetrics and Gynecology, Osaka University Graduate Schoolof Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
Shiomi et al. BMC Pregnancy and Childbirth (2019) 19:425 https://doi.org/10.1186/s12884-019-2489-y
http://crossmark.crossref.org/dialog/?doi=10.1186/s12884-019-2489-y&domain=pdfhttp://orcid.org/0000-0001-5725-9994http://creativecommons.org/licenses/by/4.0/http://creativecommons.org/publicdomain/zero/1.0/mailto:[email protected]
3. Although high levels of estrogen (which has apromoting effect on endometrioid carcinoma) andprogesterone (which has an anti-tumor effect onendometrioid carcinoma) were observed, mostauthors reported that the endometrioid carcinomaassociated with pregnancy had a good prognosiswith minimal myometrial invasion.
BackgroundEndometrial carcinoma (EC) is the fourth most commoncancer in women in high-income countries; however, ECcommonly occurs in peri- or postmenopausal women,and only 5% of women are diagnosed with adenocarcin-oma before the age of 40 years [1, 2]. Therefore, thecoexistence of EC and pregnancy is rare. Moreover, ECis rarely detected during pregnancy or within a yearpostpartum because the tumor can disrupt the preg-nancy. Although a previous study had already reviewedthe latest 35 reports on EC coexisting with pregnancyduring the last 80 years [3], the outcome of EC associ-ated with pregnancy and the effect of pregnancy on ECis not well known. Previous literature review alsoshowed that there have been no reports of diagnosingEC during pregnancy in the surgical specimen ofcesarean hysterectomy. Therefore, we report a case ofEC diagnosed in a postoperative histopathological exam-ination after total hysterectomy for placenta accretaspectrum (PAS), and we additionally present the resultsof a literature review on this matter.
Case presentationA 35-year-old woman (gravida 2, para 1) was referred toour hospital due to placenta previa at gestational week31. Her medical history was unremarkable, and her pre-vious pregnancy was an uncomplicated, normal vaginal
delivery at gestational week 38. Her current pregnancywas uncomplicated except for the placenta previa. Shedenied abnormal genital bleeding before the currentpregnancy. Cervical cytology performed during earlypregnancy was negative for intraepithelial lesions. Vagi-nal ultrasonography revealed total placenta previa andone lacuna (Fig. 1a). Magnetic resonance imaging (MRI)at gestational week 31 revealed total placenta previa andloss of the myometrium between the placenta and blad-der wall (Fig. 1b). Other MRI findings of PAS such asuterine bulging, heterogenous placenta, and T2 darkband were not observed. Based on these findings, wesuspected PAS, and an emergency cesarean delivery wasperformed owing to antepartum bleeding (approximately100 mL) at gestational week 35. An abdominal midlineincision was made, and a healthy male infant weighing2274 g (− 0.42 SD) was delivered with Apgar scores of 8and 9, at 1 and 5min, respectively. The placenta was notdelivered within 30min after fetal delivery, thus requir-ing hysterectomy for PAS. Estimated blood loss was1000 mL. The postoperative course was uneventful, andthe patient and baby were discharged on the 8th postop-erative day.Part of the chorion and placenta were adhered to the
uterus (Fig. 2a). The resected uterus was divided to 7specimens in order to perform macroscopic and histo-pathological analyses. The surgical specimen showed awhite polyp measuring 2 cm, which parted from theuterine fundus and the lower uterine segment (Fig. 2b).Histopathological examination of the tumor involvingthe lower uterine segment revealed endometrioid adeno-carcinoma (Grade 1), with < 50% myometrial invasionand positive expression of estrogen and progesterone re-ceptors, in addition to PAS (Fig. 3a and b). Notably, thetumor involving the uterine fundus did not show
Fig. 1 Images for assessment of placenta accreta spectrum. a Transvaginal ultrasonography shows total placenta previa with one lacuna. bMagnetic resonance imaging (MRI) at gestational week 31 revealed total placenta previa, and the placenta was located mainly on the anteriorside. Although intraplacental T2 dark band, uterine bulging, and heterogeneous placenta were not observed, we found myometrial thinning ofthe anterior wall and loss of myometrium between the placenta and bladder wall. The black arrow indicates loss of uterine myometriumbetween the placenta and bladder wall. Based on these findings, we suspected placenta accreta spectrum. No abnormal finding was observed inthe fetus
Shiomi et al. BMC Pregnancy and Childbirth (2019) 19:425 Page 2 of 9
myometrial invasion. Histopathological findings weresimilar in both tumors located in the uterine lower seg-ment and uterine fundus. A retrospective review of theMRI images obtained during pregnancy revealed thetumor involving the uterine fundus, although involvementof the lower uterine segment was difficult to detect(Fig. 3c). We performed a laparoscopic bilateral salpingo-oophorectomy and pelvic lymphadenectomy 102 daysafter cesarean hysterectomy and confirmed the absence ofmetastases. The tumor was a stage IA lesion based on theInternational Federation of Gynecology and Obstetricssystem. Follow-up performed 4 years after cesareanhysterectomy revealed no recurrence.
Discussion and conclusionOur case demonstrated the gross and histopathologicalfindings, MRI findings, and clinical course of EC duringpregnancy. To discuss this rare condition, we performeda literature review of cases of endometrioid carcinomaassociated with pregnancy. We defined EC associatedwith pregnancy as diagnosed at delivery to within 15months after pregnancy. We performed a search ofPubMed, MEDLINE, and Scopus databases for theperiod between January 1995 and March 2019, using thefollowing key words: “endometrial cancer”, “endometrialcarcinoma”, “endometrioid cancer”, “endometrioid car-cinoma”, “corpus cancer”, “pregnancy”, “abortion”, and“postpartum” in various combinations. We excludednon-English articles, discontinued journal and thosepublished before 1995. We summarized the timing ofdiagnosis, outcome of EC, symptoms, diagnosis of histo-pathological examination, surgical stage (base on FIGO
2008) [4], and surgical treatment for EC. We also listedthe authors’ opinions and discussions about the effect ofpregnancy on the prognosis of EC.A total of 18 studies with 25 cases of EC associated
with pregnancy (including our case) have been reported[3, 5–20]; 9 cases were identified postpartum up to the14-month; 16 cases were diagnosed at the time of D&Cfor first-trimester spontaneous or elective abortion.These results suggest that clinicians should consider ECafter pregnancy even though abnormal bleeding is oftenobserved after pregnancy, and EC associated with preg-nancy is rare. Our literature review revealed that therewere no previous reports of a diagnosis of EC based onan examination of the resected uterus following cesareanhysterectomy for PAS [3, 7]. Although our case is ex-tremely rare, clinicians should check the macroscopicfinding of the resected uterus carefully regardless of theindication for hysterectomy.Our literature review showed that the histopatho-
logical classification was endometrioid adenocarcinomagrade 1–2 in 23 of the 25 cases, unknown grade of endo-metrioid adenocarcinoma in 1 of the 25 cases, andpoorly differentiated adenosquamous carcinoma in 1 ofthe 25 cases. Immunohistochemical (IHC) analysis wasperformed in 9 of the 24 cases and revealed a typicalstaining pattern as previously reported [21, 22]. Previousreports have shown that women younger than 45 yearsrarely developed EC, and the most common subtype ofclassification in younger women was endometrioidadenocarcinoma grade 1–2 [23, 24]. Although the num-ber was limited, these results suggested that pregnancydid not affect the subtype and IHC staining pattern of
Fig. 2 Macroscopic findings in the surgical specimen. a The image shows gross findings in the uterus, which was resected due to placentaaccreta spectrum. The white arrow indicates a white tumor measuring 3 cm in diameter, involving the lower uterine segment, which wasdiagnosed as endometrial carcinoma by histopathological analysis. The tumor involving the uterine fundus is not identifiable because it iscovered by the placenta. b The image shows a longitudinal section of the uterus, which was divided into 7 sections. After the placenta wasremoved, a white tumor measuring 2 cm in diameter involving the uterine fundal segment was seen. The black arrow indicates the 3-cmdiameter tumor which was endometrial carcinoma involving the lower uterine segment; the white arrow indicates the tumor involving theuterine fundus. Both tumors were soft and white, and the macroscopic findings were similar in both tumors
Shiomi et al. BMC Pregnancy and Childbirth (2019) 19:425 Page 3 of 9
EC. We considered that our literature review might bebiased because we could include only published litera-ture and cases that made it to the scientific publicationstage and this condition might be under-reported; thus,this is the limitation of our study.The case we presented is rare, and this report high-
lights several interesting points, as follows: 1. It describesthe histopathological analysis of EC during pregnancy; 2.It describes a tumor involving the lower uterine segmentand simultaneously the uterine fundus; and 3. Itdescribes the MRI appearance of EC during pregnancy.Histopathological examination of the specimen re-
vealed EC that presented as a well-differentiated adeno-carcinoma with a focal cribriform pattern, back-to-backstructure, and a papillary area. Although IHC analysisshowed positive expression of estrogen and progesteronereceptors, our patient did not demonstrate any metasta-ses, and no recurrence was observed 4 years after thecesarean hysterectomy. These features resemble those of
typical grade 1 endometrioid adenocarcinoma [25–27].We concluded that the high-dose estrogen and proges-terone condition during pregnancy did not promote pro-gression of the EC. As shown in Table 1, most authorsconsidered that pregnancy did not worsen the prognosisof EC. Further cases are expected to discuss how thepregnancy affects the prognosis of EC. Moreover, thehistopathological and IHC findings in our case showedsimilar pattern to those of typical EC.The reason for the presentation of separate tumors at
the uterine fundus and lower uterine segment isunknown. Histopathological analysis of both tumorsshowed similar findings; thus, we concluded that thetumor presented as 2 separate growths at the aforemen-tioned sites owing to enlargement of the uterus duringpregnancy (although this remains speculative). Otherpossibilities considered were metastasis or multi-site in-volvement of EC. Myometrial invasion was insignificant;thus, we excluded metastasis as a possible etiology. The
Fig. 3 Postoperative analysis of histopathological findings, magnetic resonance imaging, and immunohistochemistry staining. a The image showsthe histopathological findings in the resected uterine specimen. Well-differentiated adenocarcinoma with focal cribriform pattern, back-to-backstructure without intervening stroma, and a papillary area are observed, and the glands have a smooth luminal contour. The tumor showspredominant glandular growth and a < 5% nonsquamous solid component; thus, the tumor was diagnosed as endometrial cancer grade 1. Thetumor at the lower uterine segment shows slight myometrial invasion. The white arrow indicates the tumor in the uterine lower segment whichshows invasion of the placenta decidua and uterine myometrium. The black arrow indicates < 50% myometrial invasion (hematoxylin and eosinstain, × 40.) b Immunohistochemistry analysis showed positive expression of estrogen and progesterone receptors, and negative expression ofp53. (Magnification, × 40.) c Retrospectively reviewed magnetic resonance imaging (MRI) revealed endometrial carcinoma in the uterine fundus. Asagittal T2-weighted MR image shows endometrial carcinoma measuring 3 cm in diameter with signal intensity resembling that of the placenta.The white arrow indicates endometrial carcinoma involving the uterine fundus
Shiomi et al. BMC Pregnancy and Childbirth (2019) 19:425 Page 4 of 9
Table
1Asummaryof
theliteraturereview
finding
sforen
dometrio
idcarcinom
aassociated
with
preg
nancy
Firstauthor
Year
(Referen
cenu
mbe
r)
Age
(years)
Timingof
diagno
sis
Outocom
ePerio
dafter
diagno
sis
Symptom
sTheresults
ofhistop
atho
gical
exam
ination
Immun
ohisotoche
ical
staining
Stage
Surgicaltreatm
ent
Kovács
AG
1996
[5]
35Abo
rtion
NA
NED
1year
Abn
ormalge
nital
bleeding
EAgrade1–2
NA
IABrachytherapy+TA
H+BSO+RT
Theauthorshypo
thesized
that
preg
nancymay
adverselyaffect
thetumor
grow
th;how
ever,itcann
otbe
proven
becauseof
thelim
itednu
mbe
rof
cases.
KodamaJ
1997
[6]
30Po
stpartum
7mon
ths
DOD
8 mon
ths
Abn
ormalge
nital
bleeding
Poorlydifferentiated
aden
osqu
amou
scarcinom
a
NA
IIIC
C
Theauthorsop
ined
that
anim
mature,prog
esterone
-unrespo
nsiveen
dometriu
mcouldbe
thepo
ssiblemechanism
ofallowingen
dometrialcarcino
mato
developin
preg
nancy.
Schammel
DP
1998
[7]
38Abo
rtion
9weeks
NED
58 mon
ths
Infertility
EAgrade1
NA
IARepe
atcurettagewith
prog
esterone
therapy
41Abo
rtion
13weeks
NED
48 mon
ths
Abn
ormalge
nital
bleeding
EAgrade1
NA
IATA
H+BSO
29Abo
rtion
9–10
weeks
NA
NA
Non
eEA
grade1
NA
IANA
34Abo
rtion
13weeks
NED
12 mon
ths
Abn
ormalge
nital
bleeding
EAgrade1
NA
IATA
H+BSO
33Po
stpartum
During
cesarean
delivery
NED
57 mon
ths
Non
eEA
grade1
NA
IARepe
atcurettagewith
prog
esterone
therapy
Theauthorsconsidered
that
thefate
ofthemoreadvanced
-stage
tumorswith
deep
ermyometrialinvasionor
high
-grade
cytologicfeatures
may
beless
subjectto
theprotectiveeffectsof
gestational
prog
esterone
.
Ayhan
A1999
[8]
44Abo
rtion
5weeks
NA
NA
Abn
ormalge
nital
bleeding
EAgrade1
NA
IATA
H+BSO+LN
D+OM
Theauthorscitedaprevious
repo
rtwhich
observed
that
hCGinhibitstheDMBA
-indu
cedbreastcarcinog
enesisin
ratsthroug
han
insulin-like
grow
thfactor-dep
ende
ntmechanism
.
Foersterling
DL
1999
[9]
31Po
stpartum
9weeks
NED
1year
Abn
ormalge
nital
bleeding
EAgrade1
NA
IATA
H+BSO
Theauthorsop
ined
that
inpreg
nancy-associated
endo
metrialcarcino
ma,partof
theliningun
dergoe
sge
stationalchang
e,whe
reas
anothe
rpartbe
comes
neop
lastic.The
portionof
theen
dometriu
mwhich
becomes
neop
lasticmay
besensitive
toestrog
en,yet
unrespon
sive
toprog
esterone
.
Vaccarello
L1999
[10]
35Abo
rtion
9weeks
NED
31 mon
ths
Abn
ormalge
nital
bleeding
EAgrade1
NA
IATA
H+BSO
40Po
stpartum
4mon
ths
NED
6years
Abn
ormalge
nital
bleeding
EAgrade1
NA
IATA
H+BSO
32Po
stpartum
4mon
ths
NED
3.5years
Abn
ormalge
nital
bleeding
EAgrade2
NA
NA
TAH+BSO
They
conclude
dthat
with
concom
itant
secretoryen
dometriu
m,the
malignant
region
smustbe
prog
esterone
refractory.
Mitsushita
J2000
[11]
28Po
stpartum
6mon
ths
NA
NA
Previous
historyof
endo
metrio
idcarcinom
a
EAgrade1
ER:p
ositive
PR:p
ositive
IATA
H
Theauthorsdidno
tdiscusstheassociationbe
tweenpreg
nancyanden
dometrio
idcarcinom
a.
Shiomi et al. BMC Pregnancy and Childbirth (2019) 19:425 Page 5 of 9
Table
1Asummaryof
theliteraturereview
finding
sforen
dometrio
idcarcinom
aassociated
with
preg
nancy(Con
tinued)
Firstauthor
Year
(Referen
cenu
mbe
r)
Age
(years)
Timingof
diagno
sis
Outocom
ePerio
dafter
diagno
sis
Symptom
sTheresults
ofhistop
atho
gical
exam
ination
Immun
ohisotoche
ical
staining
Stage
Surgicaltreatm
ent
Kovács
AG
1996
[5]
35Abo
rtion
NA
NED
1year
Abn
ormalge
nital
bleeding
EAgrade1–2
NA
IABrachytherapy+TA
H+BSO+RT
IshiokaS
2000
[12]
25Po
stpartum
14mon
ths
NED
6 mon
ths
Abn
ormalge
nital
bleeding
EAgrade1
ER:p
ositive
PR:neg
ative
p53:ne
gative
IAmRH
+BSO+LN
D
Theauthorsconclude
dthat
theoccurren
ceof
postpartum
ECwas
extrem
elyrare
prob
ablydu
eto
theanti-tumor
effectsof
prog
esterone
.
IchikawaY
2001
[13]
35Po
stpartum
6mon
ths
NED
3.5years
Lower
abdo
minal
pain
EAgrade1
NA
IBTA
H+BSO+LN
D+OM+
App
ende
ctom
y
Theauthorsspeculated
that
high
prog
esterone
levelsdu
ringpreg
nancymay
protectagainstEC
.
ItohK
2004
[14]
39Po
stpartum
6mon
ths
NED
3years
Abn
ormalge
nital
bleeding
EAgrade1
ER:neg
ative
PR:neg
ative
IBTA
H+BSO+LN
D
Theauthorsconclude
dthat
theanticancereffect
ofprog
esterone
durin
gpreg
nancywas
ineffect
inthesetumors.
Hannu
naKY
2009
[3]
34Abo
rtion
12weeks
NED
18 mon
ths
Abo
rtion
EAgrade1–2
ER:p
ositive
PR:p
ositive
CK7:p
ositive
CK20:ne
gative
β-hC
G:neg
ative
E-cadh
erin:p
ositive
EpCAM:p
ositive
Placen
talalkaline
phosph
atase:po
sitive
IAD&C
Theauthorsspeculated
that
thepresen
ceof
ECmight
have
been
relatedto
ahypo
xicdamageof
thechorionicvilli.Itmight
sugg
estacausalcorrelationbe
tweenen
dometrialm
alignancyand
spon
tane
ousabortio
n.
Theauthorsfoun
dthat
mostcase
repo
rtsof
firsttrim
esterEA
arealso
repo
rted
asarisingin
afocallesion.
Terada
T2009
[15]
29Con
curren
ten
dometrial
aden
ocarcino
maandan
early
preg
nancyloss
NA
NA
Abo
rtion
EAgrade2
ER:p
ositive
PR:p
ositive
p53:po
sitive
vimen
tin:positive
CA19–9:focalpo
sitive
CA125:po
sitive
Ki-67:80%
labe
lling
CEA
:neg
ative
PTEN
:neg
ative
p16:ne
gative
NA
Repe
atcurettagewith
out
prog
esterone
therapy
Theauthorsconsidered
that
ECassociated
with
preg
nancyweremostly
instages
IA,and
werehistolog
icallyEA
s.
AkilA
2012
[16]
45Con
curren
ten
dometrial
aden
ocarcino
maandan
early
preg
nancyloss
NA
NA
Abo
rtion
EAgrade1
NA
IATA
H+BSO+LN
D
Theauthorsconclude
dthat
theroutinehistolog
icalexam
inationof
thecurettagespecim
ensforallfirsttrim
esterabortio
ns,ind
epen
dent
oftheageof
thepatient,sho
uldbe
encouraged
.
SaciragicL
2014
[17]
36Abo
rtion
8weeks
NA
NA
Abn
ormalge
nital
bleeding
EAgrade1
Ki67:p
ositive
IATA
H+BSO+LN
D
Shiomi et al. BMC Pregnancy and Childbirth (2019) 19:425 Page 6 of 9
Table
1Asummaryof
theliteraturereview
finding
sforen
dometrio
idcarcinom
aassociated
with
preg
nancy(Con
tinued)
Firstauthor
Year
(Referen
cenu
mbe
r)
Age
(years)
Timingof
diagno
sis
Outocom
ePerio
dafter
diagno
sis
Symptom
sTheresults
ofhistop
atho
gical
exam
ination
Immun
ohisotoche
ical
staining
Stage
Surgicaltreatm
ent
Kovács
AG
1996
[5]
35Abo
rtion
NA
NED
1year
Abn
ormalge
nital
bleeding
EAgrade1–2
NA
IABrachytherapy+TA
H+BSO+RT
Theauthorsdiscussedthat
inawom
anwith
prog
esterone
-resistant
endo
metriu
m,d
evelop
men
tof
endo
metrialcarcino
macouldbe
potentiatedby
therelativelyhype
restroge
nicen
vironm
entof
early
preg
nancyandsubseq
uentlyallowed
toproliferate
furthe
rdu
eto
alack
ofrespon
seto
prog
esterone
.
Bayoglu
TekinY
2014
[18]
36Abo
rtionor
ectopic
preg
nancy
NA
NED
1year
Ectopicpreg
nancy
EAgrade1
NA
NA
Curettage
with
prog
esterone
therapy
Theauthorsthou
ghthat
thepresen
ceof
ECmight
have
been
relatedto
thedamageof
thechorionicvilli,sug
gestingacausalcorrelationbe
tweenEC
andspon
tane
ousabortio
ns.
Zhou
F2015
[19]
40Con
curren
ten
dometrial
aden
ocarcino
maandan
early
preg
nancyloss
NA
NA
Abo
rtion
EAgrade1
ER:p
ositive
PR:p
ositive
p53:ne
gative
NA
Repe
atcurettagewith
out
prog
esterone
therapy
33Con
curren
ten
dometrial
aden
ocarcino
maandan
early
preg
nancyloss
NA
NA
Abo
rtion
EAgrade1
ER:p
ositive
PR:p
ositive
p53:ne
gative
NA
Repe
atcurettagewith
out
prog
esterone
therapy
Theauthorsconsidered
that
thecarefulh
istologicalexaminationof
thecurettagespecim
ensforallfirsttrim
esterpreg
nancylosses
shou
ldbe
encouraged
.
RizzutoI
2019
[20]
29Preg
nancyof
7weeks
gestation
NA
NED
8years
Abn
ormalge
nital
bleeding
EANA
NA
Serialend
ometrialb
iopsywith
insertionof
aLevono
rgestrel
intrauterin
ede
vice
Con
servativemanagem
entforEC
inyoun
gwom
enispo
ssibleinclud
ingacase
with
anincide
ntaldiagno
sisin
preg
nancy.
Our
case
2019
35Placen
taaccreta
spectrum
Cesarean
hysterectomy
NED
4years
Non
eEA
grade1
ER:p
ositive
PR:p
ositive
p53:ne
gative
IACesareanhysterectomy
Laparoscop
icBSO+LN
D
List
ofab
breviatio
ns:B
SOBilateralsalping
o-oo
phorectomy,CChe
mothe
rapy
,CK7
Cytok
eratin
7,CK
20Cytok
eratin
20,C
A19–9
Can
ceran
tigen
19–9
,CA125Can
ceran
tigen
125,
CEACarcino
embryo
nican
tigen
,D&C
Dilatatio
nan
dcurettag
e,DODDeadof
disease,
EAEA
,ECen
dometrio
idcarcinom
a,EpCA
MEp
ithelialcella
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Shiomi et al. BMC Pregnancy and Childbirth (2019) 19:425 Page 7 of 9
possibility of multi-site involvement of EC is difficult toexclude; however, the estimated frequency of this condi-tion is low. Therefore, we concluded that the tumor sep-aration could be attributed to the uterine enlargementduring pregnancy.MRI scans were retrospectively analyzed after the
cesarean hysterectomy. We observed a lesion in theuterine fundus measuring approximately 3 cm in diam-eter with signal intensity similar to that of the placenta.Notably, this lesion was separate from the placenta. Cli-nicians must consider the possibility of EC in womenwith MRI scans showing such lesions during pregnancy.In conclusion, our findings in this case suggest that
careful analysis of MRI findings during pregnancy andgross examination of the resected uterus (in patientsundergoing hysterectomy for obstetric complications)are essential, although EC during pregnancy is extremelyrare. The literature review suggested that EC associatedwith pregnancy seemed to have a good prognosis.
AbbreviationsD&C: Dilatation & Curettage; EC: Endometrial carcinoma;IHC: Immunohistochemical; MRI: Magnetic resonance imaging; PAS: Placentaaccreta spectrum
AcknowledgementsThe authors thank H. Abe and K. Sakiyama for administrative assistance inthe preparation of this manuscript.
Authors’ contributionsMS, SM, EK, and YU made substantial contributions to conception anddesign, collected the clinical data and drafted as well as revised themanuscript. EK, TH, SN, TTa, TTo, and KM helped in reviewing the previousstudies and drafting the manuscript. TK conceived and generally supervisedof this study, and gave final approval of the version to be published. Allauthors read and approved the final manuscript.
FundingThere is no source of financial support or funding.
Availability of data and materialsNot applicable.
Ethics approval and consent to participateThis study was approved by the Institutional Review Board and the EthicsCommittee of the Osaka University Hospital (approval #15240, approved onSeptember 10, 2015).
Consent for publicationWritten informed consent was obtained from the patient for publication ofthis case report and any accompanying images. A copy of the writtenconsent is available for review by the Editor of this journal.
Competing interestsShinya Matsuzaki is an Associate Editor for BMC Pregnancy and Childbirth.The authors declare no conflicts of interest about this study. All of authorshave no competing financial interests regarding this study.
Received: 3 June 2019 Accepted: 4 September 2019
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AbstractBackgroundCase presentationConclusion
BackgroundCase presentationDiscussion and conclusionAbbreviationsAcknowledgementsAuthors’ contributionsFundingAvailability of data and materialsEthics approval and consent to participateConsent for publicationCompeting interestsReferencesPublisher’s Note