A case of endometrial adenocarcinoma in a patient with Turner's syndrome who had received long term combined oestrogen-progestogen therapy is described.
PIP: This is a case report of endometrial adenocarcinoma in a patient with Turner's syndrome who had received estrogen-progestogen therapy for 13 years. At age 22 she was treated for primary amenorrhea and absence of secondary sexual characteristics. Urinary gonadotropin assay exceeded 32 mouse units/24 hours and infantile external genitalia, uterine hypoplasia, and impalpable ovaries were found. Cytogenetic studies confirmed a 45XO karyotype. For 13 years she received stilbestrol cyclically for 21 days with ethisterone, 5 mg twice daily, added for Days 16-21 of each cycle. Secondary sexual characteristics developed. After 13 years anemia developed, the uterus was found to be the size of a 20-week pregnancy, and an endometrial polyp protruding through the cervix showed squamous metaplasia. Following hysterectomy, histologic studies showed well-differentiated adenocarcinoma of the endometrium with some squamous metaplasia and osteoid formation. Metastases were not found. Similar cases treated with stilbestrol alone have been reported. Genetic predisposition is possible with this patient's X chromosome abnormality. However, estrogen therapy is thought to be a causative factor. Those receiving such therapy should have periodic gynecological examinations with curettage even when progestogens are also being used.