Endometrial Carcinoma in a Gravid Uterus: A Case Report

Abstract

Endometrial carcinoma is predominantly a postmenopausal disease and is extremely rare during pregnancy due to the protective effect of progesterone and the typically young age of pregnant women. This case report presents a rare incidence of endometrial carcinoma diagnosed in a gravid uterus, highlighting the diagnostic challenges, management dilemmas, and outcomes.

Introduction

Endometrial carcinoma is the most common gynecologic malignancy in developed countries, with the majority of cases occurring in postmenopausal women. Its occurrence during pregnancy is exceedingly rare, with fewer than 100 cases reported in the literature. Pregnancy, characterized by high circulating levels of progesterone, is generally considered protective against the development of endometrial malignancy. When it does occur, diagnosis is often delayed or incidental, posing significant challenges in management due to the competing priorities of maternal treatment and fetal viability.

Case Presentation

A 32-year-old primigravida at 12 weeks of gestation presented with abnormal vaginal bleeding. Her antenatal course had been unremarkable until this episode. Transvaginal ultrasonography revealed a viable intrauterine pregnancy with a thickened and heterogeneous endometrium.

An endometrial biopsy was performed after careful counselling and consent due to persistent bleeding and abnormal imaging findings. Histopathological examination revealed well-differentiated endometrioid adenocarcinoma. MRI confirmed localized disease confined to the endometrium without myometrial or extrauterine invasion. The patient had no significant personal or family history of malignancy.

A multidisciplinary team, including obstetricians, gynecologic oncologists, and maternal-fetal medicine specialists, was involved in the case discussion. After thorough counselling regarding prognosis, maternal-fetal risks, and treatment options, the patient opted for pregnancy termination followed by definitive management. She subsequently underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Final histopathology confirmed stage IA, grade 1 endometrioid adenocarcinoma with no lymphovascular invasion.

Discussion

Endometrial carcinoma in pregnancy is rare, often detected incidentally or due to persistent abnormal bleeding. Risk factors may include obesity, polycystic ovary syndrome (PCOS), and nulliparity, though none were present in this case. Diagnosis is particularly challenging during pregnancy due to overlapping symptoms such as bleeding and imaging limitations.

The management of endometrial carcinoma in pregnancy depends on gestational age, histological grade, stage, and the patient's desire for fertility preservation. In early-stage, low-grade cases, conservative management may be considered; however, this must be balanced against the risk of disease progression. In this case, the decision for pregnancy termination allowed for definitive surgical management with a favorable prognosis.

Conclusion

Endometrial carcinoma during pregnancy is extremely rare and requires a high index of suspicion when evaluating persistent or unexplained bleeding in early gestation. Early diagnosis through imaging and biopsy, coupled with individualized, multidisciplinary management, is crucial for optimal outcomes. This case underscores the importance of vigilance and careful counselling in managing rare malignancies in pregnancy.