Occult myometrial recurrence after progesterone therapy to preserve fertility in a young patient with endometrial cancer

Objective: We report a case of endometrial cancer treated by fertility-preserving P therapy, who subsequently presented with an abnormal magnetic resonance imaging (MRI) of the myometrium despite normal endometrial biopsies. Design: Case report. Setting: Tertiary referral university hospital. Patient(s): A 31-year-old patient with grade 1, stage I endometrial cancer presented for treatment with fertility-preserving P therapy. Multiple endometrial samples were all normal. Four years later, she presented with an abnormal pelvic MRI in the absence of any other signs or symptoms. Hysterectomy and oophoropexy confirmed normal endometrium with deeply invasive cancer. She remains cancer-free 2 years later with two normal children from surrogacy. Intervention(s): Progestogen therapy, laparoscopic-assisted vaginal hysterectomy, oophoropexy, and assisted reproductive techniques (ART) and surrogate. Main Outcome Measure(s): Cancer disease status and fertility preservation. Result(s): Eight years after initial diagnosis, the patient remains cancer free and has conceived by surrogate reproductive techniques. Conclusion(s): Reproductive options remains a meaningful quality of life goal even for patients with cancer. Routine pelvic MRI should be considered for follow-up of endometrial cancer patients who retain their uterus. Hysteroscopy and dilation and curettage may not be sufficient.