Endometrial cancer with para-aortic lymph node metastasis following medroxyprogesterone acetate therapy: A case report

J Obstet Gynaecol Res. 2025 Jan;51(1):e16217. doi: 10.1111/jog.16217.

Abstract

Medroxyprogesterone acetate (MPA) is a promising fertility-sparing treatment for early stage endometrial cancer; however, it has a high recurrence rate and is inferior to surgery. Although the site of recurrence is mostly the endometrium, we here report a case of metastatic recurrence to the para-aortic lymph node with endometrial recurrence despite a careful follow-up. A 31-year-old woman was diagnosed with grade 1 endometrioid carcinoma, stage IA without myometrial invasion. She requested fertility-sparing treatment and underwent a 48-week MPA therapy with complete remission. Follow-up continued with ultrasonography and endometrial biopsy every 3 and 6 months, respectively; however, at 10 months following MPA therapy, cancer recurrence was detected in the endometrium and para-aortic lymph node, requiring hysterectomy, bilateral adnexectomy, and lymph node dissection, followed by paclitaxel/carboplatin chemotherapy. This case report highlights that lymph node recurrence can develop despite careful follow-up following complete remission with MPA therapy for stage IA endometrial cancer.

Keywords: endometrial cancer; lymph node; metastasis; progesterone; recurrence.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Agents, Hormonal / administration & dosage
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Carcinoma, Endometrioid / drug therapy
  • Carcinoma, Endometrioid / pathology
  • Carcinoma, Endometrioid / surgery
  • Endometrial Neoplasms* / drug therapy
  • Endometrial Neoplasms* / pathology
  • Female
  • Humans
  • Lymphatic Metastasis*
  • Medroxyprogesterone Acetate* / administration & dosage
  • Neoplasm Recurrence, Local / drug therapy

Substances

  • Medroxyprogesterone Acetate
  • Antineoplastic Agents, Hormonal