Endometrial carcinoma in gonadal dysgenesis with and without estrogen therapy

Girls with Turner's syndrome with spontaneous menarche have an increased risk of endometrial carcinoma: a case report and review from the literature

BACKGROUND

Patients with Turner's syndrome receiving unopposed estrogens for the induction of feminization have an increased risk of endometrial carcinoma. Only seven patients who were not treated with estrogen replacement therapy have been reported to have developed endometrial carcinoma at different age levels.

CASE

A young girl with Turner's syndrome phenotype, spontaneous puberty, and karyotype 45,X0/47,XXX from peripheral blood, after irregular menstrual cycles of 9 years, at the age of 21, was diagnosed with a non-invasive well-differentiated endometrial carcinoma confined to a hyperplastic endometrial polyp. Analysis of the ovarian tissue by FISH confirmed mosaicism: 45,X0/46,XX/47,XXX.

CONCLUSION(S)

The endogenous estrogen secretion from the ovaries might have caused malignancy in this case. Patients with Turner's syndrome with spontaneous menarche might carry a higher risk of endometrial carcinoma.

Endometrial carcinoma in 45,X Turner's syndrome without hormone replacement therapy

An endometrial carcinoma developing in a patient with pure Turner's syndrome was described. The patient showed typical Turner's phenotype and analysis of karyotype revealed only 45,X. Secondary sexual development had been seen until age 20 and she had no history of hormone replacement therapy (HRT). The enlarged uterus and normal appearance of bilateral ovaries were detected at laparotomy. A well-differentiated adenocarcinoma of the endometrium and a graafian follicle of the left ovary were histologically confirmed. This seems to be the first report of the occurrence of endometrial carcinoma in possibly pure Turner's syndrome without HRT.

Endometrial carcinoma in premenopausal women: a clinicopathological study

A clinicopathological review of 106 cases of premenopausal endometrial carcinoma has confirmed the good prognosis in such patients. Women less than 40 years old were more likely to be nulliparous, over 80 kg in weight, and to present with irregular or heavy and irregular bleeding, than women 40 years or older. Seven patients developed malignancies at other sites. A detailed pathological review of 32 cases revealed poor prognostic features in 30% of patients; corpora lutea were identified in the ovaries of 13 patients. It is suggested that factors other than anovulation are related to the development of endometrial cancer in the over 40 age group.

Endometrial carcinoma in young women

Endometrial carcinoma in young women is uncommon. The majority of cases occur in women who have been taking oestrogen-containing oral contraceptives, in those with the Stein-Leventhal syndrome, or in those with gonadal dysgenesis treated by long-term oestrogen replacement therapy. We have observed 4 women under 40 years of age with adenocarcinoma of the uterus in whom chromosomal abnormalities associated with Turner's syndrome were confirmed only after the diagnosis of carcinoma had been made. None of these had received replacement oestrogen therapy. It is postulated that chromosomal abnormalities in young women with endometrial carcinoma are more common than previously thought. As the disease in this group appears to behave in a benign fashion, a conservative approach to therapy is advocated.

Ultrasound examination of pubertal girls and of patients with gonadal dysgenesis

Girls with hypogonadism caused by hypothalamic lesions or chromosomal abnormalities need accurate pelvic exams to delinate pelvic structures. This work presents an evaluation of the usefulness of ultrasound examination of the pelvis in females with aberrant sexual development. Girls with these problems often need multiple pelvic examinations to monitor their uterine response to hormone therapy. Thirty-two patients with a variety of abnormalities including Mullerian agenesis and hypothalamic hypogonadism as well as patients with abnormal karyotype commonly associated with gonadal dysgenesis and male pseudohermaphrodism were studied. Repeat ultrasound scans were performed to quantitate uterine response to therapy. Ovarian visualization was usually possible, even in prepuberal girls. Following some patients at risk for gonadal tumors may be possible using repeat ultrasound examinations. The cooperation of the patients as well as of their families was gratifying, and the girls appeared to be more relaxed during ultrasound examination than during a pelvic examination.