Ineffective attempt to preserve fertility with a levonorgestrel-releasing intrauterine device in a young woman with endometrioid endometrial carcinoma: a case report and review of the literature

Background: The treatment of endometrial cancer in young women who want to preserve their fertility is challenging. Case: A 25-year-old woman (A0P0G0) was diagnosed with grade 1 endometrioid endometrial carcinoma (EEC). Imaging studies including transvaginal ultrasound (TVS), computed tomography and magnetic resonance imaging (MRI) could not detect myometrial invasion or metastatic disease. The immunohistochemical expression of the estrogen and progesterone receptor in the tumor was strongly positive, whereas p53 staining was negative. After extensive Counseling, we decided to use a levonorgestrel-releasing intrauterine device to preserve her fertility. Follow-up Was organized every three months and consisted of serum CA 125 levels, TVS, endometrial biopsy and MRI. The tumor regressed after ten months and the intrauterine device was removed. However, nine months later, recurrent EEC was diagnosed and a hysterectomy performed. Pathological examination confirmed Stage la EEC. Conclusion: Despite the presence of favorable prognostic factors of EEC as determined by grade and immunohistochemistry, the levonorgestrel-releasing intrauterine device was unable to preserve fertilit