Endometrial Cancer Arising in Adenomyosis That Could Not Be Diagnosed by Endometrial Biopsy: A Case Report

Tetsuro Oishi, Shinya Sato, Fuminori Taniguchi, Tasuku Harada, Jun Chikumi, Takaya Nakaso, Mayumi Sawada, Akiko Kudoh, Hiroaki KOMATSU
In: Yonago Acta Medica · 2022 · vol. 65(1) , pp. 106–110 · W7144846095
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 63-year-old female with endometrial cancer arising in adenomyosis that was not diagnosed by repeated endometrial biopsies, emphasizing the need to consider EC-AIA even with negative biopsy results.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This paper reports a case of endometrial cancer arising in adenomyosis (EC-AIA) in a 63-year-old woman with endometrial thickening, using endometrial cytology, MRI, repeated endometrial biopsies, and eventual diagnostic hysterectomy. Initial MRI suggested shallow-invading endometrial cancer with adenomyosis, but the first biopsy showed only metaplasia, and multiple subsequent biopsies failed to establish malignancy despite cytology changes suggestive of atypical endometrial glandular cells. The patient underwent diagnostic hysterectomy 19 months later, and postoperative pathology confirmed stage IA endometrial cancer (endometrioid carcinoma G1). The case highlights that EC-AIA should be considered even when endometrial biopsy detects no definitive malignant lesion, though it is limited by being a single case report. This paper is centrally about endometriosis/adenomyosis—specifically, it describes endometrial cancer arising in adenomyosis (EC-AIA) with repeated biopsy-negative findings.

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Abstract

Uterine adenomyosis is an estrogen-dependent tumor and one of the most common benign diseases in sexually mature women. The frequency of endometrial cancer associated with adenomyosis has been reported to be 18%–66%. On the other hand, endometrial cancer arising in adenomyosis (EC-AIA) is extremely rare. EC-AIA is now considered a different entity from and has a worse prognosis than endometrial cancer with adenomyosis (EC-A). In the present study, we report a case of endometrial cancer with adenomyosis in which endometrial biopsy failed to provide a definitive diagnosis. A 63-year-old female patient presented with endometrial thickening. Endometrial cytology was positive, and magnetic resonance imaging (MRI) showed small lesions suggestive of endometrial cancer with shallow invasion and adenomyosis. However, an endometrial biopsy showed only metaplasia, and careful follow-up was initiated. Subsequent endometrial cytology showed enlarged and round nuclei, uniform chromatin distribution, no thickening of nuclear margins, and abundant cytoplasm appearing in a sheet-like arrangement, suggesting atypical cells of endometrial glands with metaplasia. Three suspicious positive results and one positive result were observed, but repeated biopsies did not lead to the diagnosis of malignancy. The patient underwent diagnostic hysterectomy 19 months after the initial visit. The postoperative histopathological diagnosis was stage IA endometrial cancer (endometrioid carcinoma G1). This case of endometrial cancer associated with adenomyosis was difficult to diagnose. Our findings demonstrate that EC-AIA should be considered even if no lesions were detected by endometrial biopsy.
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WEKO3 アイテム Endometrial Cancer Arising in Adenomyosis That Could Not Be Diagnosed by Endometrial Biopsy: A Case Report https://repository.lib.tottori-u.ac.jp/records/4638 https://repository.lib.tottori-u.ac.jp/records/463845d63776-8077-498a-b647-e3f6557e22eb | 名前 / ファイル | ライセンス | アクション | |---|---|---| | yam65(1)_106.pdf (4.6 MB) | | | アイテムタイプ | 学術雑誌論文 / Journal Article(1) | ||||||||||| |---|---|---|---|---|---|---|---|---|---|---|---|---| | 公開日 | 2022-03-09 | ||||||||||| | タイトル | |||||||||||| | タイトル | Endometrial Cancer Arising in Adenomyosis That Could Not Be Diagnosed by Endometrial Biopsy: A Case Report | ||||||||||| | 言語 | en | ||||||||||| | 言語 | |||||||||||| | 言語 | eng | ||||||||||| | キーワード | |||||||||||| | 主題 | adenomyosis | ||||||||||| | キーワード | |||||||||||| | 主題 | endometrial cancer | ||||||||||| | キーワード | |||||||||||| | 主題 | gynecologic oncology | ||||||||||| | キーワード | |||||||||||| | 言語 | en | ||||||||||| | 主題 | adenomyosis | ||||||||||| | キーワード | |||||||||||| | 言語 | en | ||||||||||| | 主題 | endometrial cancer | ||||||||||| | キーワード | |||||||||||| | 言語 | en | ||||||||||| | 主題 | gynecologic oncology | ||||||||||| | 資源タイプ | |||||||||||| | 資源タイプ | journal article | ||||||||||| | 著者 | 大石, 徹郎 × 大石, 徹郎× 佐藤, 慎也× 谷口, 文紀 WEKO 3792 × 原田, 省× Chikumi, Jun× Nakaso, Takaya× Sawada, Mayumi× Kudoh, Akiko× Komatsu, Hiroaki | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University / Department of Obstetrics and Gynecology, Matsue City Hospital | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 著者所属（英） | |||||||||||| | 言語 | en | ||||||||||| | 値 | Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University | ||||||||||| | 抄録 | |||||||||||| | 内容記述タイプ | Other | ||||||||||| | 内容記述 | Uterine adenomyosis is an estrogen-dependent tumor and one of the most common benign diseases in sexually mature women. The frequency of endometrial cancer associated with adenomyosis has been reported to be 18%–66%. On the other hand, endometrial cancer arising in adenomyosis (EC-AIA) is extremely rare. EC-AIA is now considered a different entity from and has a worse prognosis than endometrial cancer with adenomyosis (EC-A). In the present study, we report a case of endometrial cancer with adenomyosis in which endometrial biopsy failed to provide a definitive diagnosis. A 63-year-old female patient presented with endometrial thickening. Endometrial cytology was positive, and magnetic resonance imaging (MRI) showed small lesions suggestive of endometrial cancer with shallow invasion and adenomyosis. However, an endometrial biopsy showed only metaplasia, and careful follow-up was initiated. Subsequent endometrial cytology showed enlarged and round nuclei, uniform chromatin distribution, no thickening of nuclear margins, and abundant cytoplasm appearing in a sheet-like arrangement, suggesting atypical cells of endometrial glands with metaplasia. Three suspicious positive results and one positive result were observed, but repeated biopsies did not lead to the diagnosis of malignancy. The patient underwent diagnostic hysterectomy 19 months after the initial visit. The postoperative histopathological diagnosis was stage IA endometrial cancer (endometrioid carcinoma G1). This case of endometrial cancer associated with adenomyosis was difficult to diagnose. Our findings demonstrate that EC-AIA should be considered even if no lesions were detected by endometrial biopsy. | ||||||||||| | 書誌情報 | Yonago Acta Medica en : Yonago Acta Medica 巻 65, 号 1, p. 106-110, 発行日 2022-02-22 | ||||||||||| | 出版者 | |||||||||||| | 出版者 | Tottori University Medical Press | ||||||||||| | ISSN | |||||||||||| | 収録物識別子タイプ | ISSN | ||||||||||| | 収録物識別子 | 05135710 | ||||||||||| | 書誌レコードID | |||||||||||| | 収録物識別子タイプ | NCID | ||||||||||| | 収録物識別子 | AA00892882 | ||||||||||| | DOI | |||||||||||| | 関連タイプ | isIdenticalTo | ||||||||||| | 識別子タイプ | DOI | ||||||||||| | 関連識別子 | 10.33160/yam.2022.02.009 | ||||||||||| | 権利 | |||||||||||| | 権利情報 | (C) 2022 Tottori University Medical Press. | ||||||||||| | 情報源 | |||||||||||| | 関連名称 | Yonago Acta Medica. 2022, 65(1), 106-110. doi:10.33160/yam.2022.02.009 | ||||||||||| | 関連サイト | |||||||||||| | 識別子タイプ | URI | ||||||||||| | 関連識別子 | https://www.lib.tottori-u.ac.jp/yam/yam/yam65-1/65-1contents.html | ||||||||||| | 関連名称 | https://www.lib.tottori-u.ac.jp/yam/yam/yam65-1/65-1contents.html | ||||||||||| | 関連サイト | |||||||||||| | 識別子タイプ | DOI | ||||||||||| | 関連識別子 | https://doi.org/10.33160/yam.2022.02.009 | ||||||||||| | 関連名称 | https://doi.org/10.33160/yam.2022.02.009 | ||||||||||| | 著者版フラグ | |||||||||||| | 出版タイプ | VoR | ||||||||||| | EISSN | |||||||||||| | 値 | 13468049 |

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