Conservative management of early endometrial adenocarcinoma with repeat curettage and hormone therapy under assistance of hysteroscopy and laparoscopy

We report a rare case of early-stage endometrial adenocarcinoma in a 22year old nullipara with polycystic ovaries undergoing conservativetreatment. Pretreatment evaluation including tumour grade, depth ofmyometrial invasion, tumour size, hormone receptor status and flowcytometric analysis indicated a favourable prognosis. The patient underwentrepeat endometrial curettage and a 6 month period of therapy with megestrolacetate and tamoxifen. A combination contraceptive pill was then prescribedto ensure withdrawal of the menstrual cycle thereafter. Now, 1 year afterthe last curettage, there is no evidence of disease. During the treatmentperiod, hysteroscopy allowed for a more precise approach in panoramicallyexamining the tumour nest in the endometrial cavity, and the subsequentendometrial response to hormone therapy. Laparoscopy using bulldog clampsapplied to the isthmic portion of the Fallopian tubes prevented i.p. spreadof endometrial tissue from retrograde regurgitation during hysteroscopy.Laparoscopic ovarian electrocautery resulted in the reduction of abnormalhypervascularization on the surface of polycystic ovaries postoperativelybut caused a peri-ovarian adhesion complication. It is interesting thatthis case posed a unique opportunity to demonstrate the tumour regressionunder the assistance of laparoscopy and hysteroscopy.