Endometrial polyp and the levonorgestrel intrauterine system--a case report and literature review

Sinha, Anita; Nwosu, E. C.

doi:10.1080/014436102762062448

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Given that the incidence of ovarian cancer is consistently low in Lynch syndrome series,29, 30 and given the normally excellent prognosis of clinically diagnosed EC,31 the actual survival benefits may be modest at best. To date, only case reports32–34 but no data from cohort series or clinical trials are available on the use of a levonorgestrel intrauterine device and its potential ability to prevent EC.…”

Section: Discussionmentioning

confidence: 99%

Risk of endometrial cancer for women diagnosed with HNPCC‐related colorectal carcinoma

Obermair

Youlden

Young

et al. 2010

Intl Journal of Cancer

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The risk of endometrial cancer (EC) subsequent to a diagnosis of colorectal cancer in women with a germline mutation in a mismatch repair gene [Lynch syndrome or hereditary non-polyposis colon cancer (HNPCC)] is unknown. We estimated the risk of EC following a diagnosis of colorectal carcinoma (CRC) for women with Lynch syndrome. A retrospective cohort study was performed on women diagnosed with CRC with a germline mutation in a mismatch repair (MMR) gene (Lynch syndrome cases), and women with microsatellite stable (MSS) CRC who were not known to carry a germline mutation (non-Lynch cases), identified from the Colon Cancer Family Registry. The incidence of EC following CRC was estimated and compared for women with and without Lynch syndrome, using adjusted hazards ratios calculated for time at risk among each group. A total of 112 women with Lynch syndrome and a previous diagnosis of CRC were compared with 908 women without Lynch and with a MSS CRC diagnosis. The estimated 10-year cumulative risk of EC subsequent to CRC was 23.4% [95% confidence interval (CI): 15-36%] for Lynch syndrome women compared with 1.6% (95% CI: 0.7-3.8%) for non-Lynch women. After adjusting for ascertainment, age at diagnosis and diagnosis of other cancers, risk of subsequent diagnosis with EC was elevated sixfold in women with Lynch syndrome compared with non-Lynch women (HR 6.2; 95% CI 2.2-17.3; p 5 0.001). Approximately one quarter of women diagnosed with Lynch syndrome-associated CRC developed EC within 10 years. This supports the sentinel cancer concept and suggests that active and early management is important for these women.Lynch syndrome [also known as hereditary non-polyposis colon cancer (HNPCC)] is caused by a germline mutation in one of several DNA mismatch repair (MMR) genes, MLH1, MSH2, MSH6 or PMS2. Carriers of MMR gene mutations are at increased risk of cancers of the colon, endometrium, ovary, upper urologic tract, stomach, small bowel, biliary/pancreas, skin and brain. 1 In individuals who carry such mutations, inactivation of the remaining normal allele in a cell results in dysfunctional or absent DNA MMR. These unrepaired mismatches typically occur in regions of repetitive nucleotide sequences, commonly referred to as microsatellites. The consequent phenotype, referred to as microsatellite instability (MSI), is the signature change in Lynch syndrome-associated cancers. 2,3 Detection of a deleterious germline mutation in a particular MMR gene in a case of cancer with MSI unequivocally establishes the diagnosis of Lynch syndrome, with MLH1 and MSH2 sequence variants accounting for 80% of all MMR gene mutations. 4 Early age of cancer diagnosis and multiplicity of cancers are considered hallmarks of Lynch syndrome. A meta-analysis 5 of data from three population-based studies, 6-8 and previous clinic-based work, 9 estimated that the risk of colorectal cancer for MLH1 and MSH2 carriers to age 70 years was 53% for males, 33% for females and for endometrial cancer (EC) was 44%. Although the increased risk of EC in women wi...

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Section: Discussionmentioning

confidence: 99%

Risk of endometrial cancer for women diagnosed with HNPCC‐related colorectal carcinoma

Obermair

Youlden

Young

et al. 2010

Intl Journal of Cancer

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“…Despite seemingly responding well to levonorgestrel, AH may progress to EEC after LNG-IUS insertion. Among all case reports included in Medline published in English prior to October 1, 2021, nine are cases of EEC following LNG-IUS insertion [ 5 – 12 ]. Including ours, there are 11 reported cases of EEC following LNG-IUS insertion.…”

Section: Discussionmentioning

confidence: 99%

Endometrial Cancer Following Levonorgestrel-Releasing Intrauterine System Insertion in Young Women with Atypical Hyperplasia: Two Case Reports and Literature Review

Peng

Jiang²,

Li³

2022

Reprod. Sci.

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Levonorgestrel-releasing intrauterine system (LNG-IUS) insertion is the first-line treatment for atypical hyperplasia (AH) in young women who wish to retain their fertility. However, the procedure is not always effective, and may allow AH to progress to endometrioid endometrial cancer (EEC). Two young women with AH who wished to preserve their fertility developed EEC following 52-mg LNG-IUS in insertion at our institution. One was a 34-year-old woman diagnosed with endometrial cancer 2 years after LNG-IUS insertion. The second was a 30-year-old woman diagnosed 17 months after LNG-IUS insertion. Proactive molecular risk classification for endometrial cancer (ProMisE) classification revealed that the first and second patients had p53-abnormal (p53abn) EEC and mismatch repair deficient (MMR-d) EEC, respectively. MMR-d and p 53abn were frequently observed in both AH and EEC specimens. Studies suggest that MMR-d and p53abn are predictors of the occurrence adverse effects after fertility-preserving treatment for EEC. AH is a precursor of EEC. Therefore, p53 and mismatch repair (MMR) mutation may be used to identify women with AH who will not likely benefit from progestin therapy. Molecular assays in women with AH will likely be useful for identifying novel predictive biomarkers of progestin resistance and to improve the safety of conservative treatment. Combined assessment of progesterone receptor (PR) with these predictive molecular markers may improve the predictive ability.

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“…STIs, device misplacement and pregnancy are among the differential diagnoses to bear in mind when a woman presents with a change in pattern of bleeding. Case reports have described endometrial polyps, endometrial hyperplasia 95,96 and endometrial cancer 97 in women who presented with irregular bleeding following amenorrhoea. This highlights the importance of further investigation for a woman with a new pattern of bleeding.…”

Section: Endometrial Assessment (Biopsy or Ultrasound Scan) Is Not Romentioning

confidence: 99%

FFPRHC Guidance (April 2004): The levonorgestrel-releasing intrauterine system (LNG-IUS) in contraception and reproductive health

2004

j fam plann reprod health care

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Endometrial polyp and the levonorgestrel intrauterine system--a case report and literature review

Cited by 4 publications

References 7 publications

Risk of endometrial cancer for women diagnosed with HNPCC‐related colorectal carcinoma

Risk of endometrial cancer for women diagnosed with HNPCC‐related colorectal carcinoma

Endometrial Cancer Following Levonorgestrel-Releasing Intrauterine System Insertion in Young Women with Atypical Hyperplasia: Two Case Reports and Literature Review

FFPRHC Guidance (April 2004): The levonorgestrel-releasing intrauterine system (LNG-IUS) in contraception and reproductive health

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