Asymptomatic endometrial carcinoma after endometrial ablation

Abstract

Endometrial ablation has been recently introduced as a surgical alternative to hysterectomy for the treatment of dysfunctional uterine bleeding. The procedure itself is reasonably safe. However, if occult endometrial cancer is present before the procedure and is not detected, it may be more difficult to diagnose later. Endometrial cancer may also arise de novo from missed endometrial tissue. Two cases of endometrial cancer following endometrial ablation have been reported, but its overall incidence is unknown. A 58-year-old woman was treated with endometrial ablation for dysfunctional uterine bleeding. Three years later she underwent hysterectomy and Marshall-Marchetti-Krantz procedure for urinary incontinence; incidental, asymptomatic endometrial adenocarcinoma was discovered. The final pathology was grade 1 adenocarcinoma, invading more than 50% of the myometrium (FIGO stage Ic). Endometrial cancer may occur following endometrial ablation and it may be asymptomatic. Careful patient selection and close follow-up are essential.

Endometrial cancer following endometrial resection

“…EC after endometrial ablation is a rare but possible occurrence, as described in the literature in a number of case reports [13][14][15][16][17][18][19][20][21][22]. The exact rate of EC after endometrial ablation is still unknown, but the most common symptom is recurrent abnormal bleeding and the state of cancer diagnosed is advanced in many of the cases described [14,[16][17][18][19][20].…”

“…The exact rate of EC after endometrial ablation is still unknown, but the most common symptom is recurrent abnormal bleeding and the state of cancer diagnosed is advanced in many of the cases described [14,[16][17][18][19][20].…”

“…In all of the cases described in the literature except two [13][14][15][16][17][18][19][20][21][22], the endometrial ablation was performed by rollerball coagulation. In our study, complete endometrial ablation by resecting loop was performed in three of the four cases (one of these three cases had endometrial resection by HRT, Hormone replacement therapy; TH, total hysterectomy; BSO, bilateral salpingo ophorectomy monopolar resecting loop followed by monopolar "rollerball" coagulation of the uterine cavity), while in the remaining one case complete endometrial polyps resection was performed by resecting loop followed by complete curettage of the uterine cavity.…”

“…The principle of the technique is to remove the whole thickness of the endometrium and some of the superficial myometrium to ensure complete removal of the endometrial basal glands, using a monopolar or bipolar resecting loop or coagulating electrode ("roller-ball"). However, despite the theoretically complete ablation of the endometrium, cases of endometrial cancer (EC) after endometrial ablation have been described in the literature [13][14][15][16][17][18][19][20][21][22].…”

Treatment of Recurrent Bleeding Disorders during Hormone Replacement Therapy by Transcervical Endometrial Ablation

“…Istre et al [10] showed that an estrogen therapy alone led to a higher number of hyperplasias and should be avoided. A preoperative exclusion of hyperplasia is important, because the development of endometrial carcinoma can be short [11,12]. After endometrial ablation the diagnostics of the corpus carcinoma can be difficult because the cavity is obliterated [13].…”