Endometrial cancer after endometrial ablation for adenomyosis

H. Tobai, Aya Utsuno, Miho Omura, Yuichi Jinno, Makoto Takeuchi, Noriko Yano, Miki Goto, Takahide Arimoto
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2022 · vol. 38(2) , pp. 224–229 · doi:10.5180/jsgoe.38.2_224 · W4317923849
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This study investigated the incidence of endometrial cancer following endometrial ablation performed for adenomyosis, as data on late-onset ablation failure in this context are limited.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This paper is a case report of a 53-year-old Japanese woman who underwent microwave endometrial ablation for heavy menstrual bleeding attributed to adenomyosis after uterine malignancy was excluded, with hysterectomy previously discussed due to unsuccessful medical management. Sixteen months after ablation, she presented with leg pain and was diagnosed with DVT/PE, brain infarctions, and an enlarged uterus; because malignancy was strongly suspected, she underwent abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic/aortic lymphadenectomy, which revealed endometrioid endometrial carcinoma grade 1 with a clear cell component, ultimately diagnosed as FIGO stage IVB with isolated supraclavicular lymph node metastases. The authors retrospectively reviewed prior pathological specimens and found atypical endometrial hyperplasia in the hysteroscopic resection tissue, and she received paclitaxel plus carboplatin, achieving complete remission for 7 years, with the main limitation being that the evidence is restricted to a single case. This paper is centrally about adenomyosis—specifically endometrial cancer discovered after endometrial ablation performed for adenomyosis.

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Abstract

Background: Endometrial ablation is a widely accepted conservative surgical approach for women with abnormal uterine bleeding. However, data on late-onset endometrial ablation failure are scarce. Endometrial cancer, particularly after endometrial ablation for adenomyosis, is unknown.
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Background

Endometrial ablation is a widely accepted conservative surgical approach for women with abnormal uterine bleeding. However, data on late-onset endometrial ablation failure are scarce. Endometrial cancer, particularly after endometrial ablation for adenomyosis, is unknown. Case: A 53-year-old Japanese woman had microwave endometrial ablation for heavy menstrual bleeding caused by adenomyosis after excluding uterine malignancy. Prior ablation a hysterectomy was discussed because medical management had been unsuccessful. However, she elected to preserve the uterus and underwent a hysteroscopic endometrial resection and microwave endometrial ablation. Based on histopathological findings, initially, adenomyosis was diagnosed. Sixteen months after ablation, the patient presented with sudden-onset leg pain and was diagnosed with deep vein thrombosis (DVT), pulmonary embolism (PE), multiple brain infarctions, and enlargement of the uterus. As uterine malignancy was highly suspected, abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic/aortic lymphadenectomy were performed. Histopathological analysis revealed endometrioid endometrial carcinoma grade 1 with a clear cell carcinoma component. However, later diagnosis by computed tomography showed FIGO Stage IVB presenting with isolated supraclavicular lymph node metastases. We reviewed past pathological examinations, and found atypical endometrial hyperplasia in the hysteroscopic endometrial resection specimen. Chemotherapy with paclitaxel and carboplatin was administered, which showed complete remission for 7 years.

Conclusion

Endometriosis and adenomyosis are associated with an increased risk of endometrial cancer; however, endometrial cancer following endometrial ablation may be difficult to diagnose. Further studies with patient selection and long-term surveillance are necessary to determine the safety and efficacy of endometrial ablation. © 2022 日本産科婦人科内視鏡学会

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adenomyosis

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