High-grade endometrial carcinoma in secretory endometrium in young women: a report of five cases.

Five cases of high-grade carcinoma occurring adjacent to secretory endometrium are described. One of the patients had the Lynch II syndrome, the others appeared to be sporadic. None of these cases appeared to be related to hyperestrogen. The presenting symptom in four was abnormal vaginal bleeding, and the other case was found incidentally in the course of investigations for infertility. There were delays in diagnosis due to the patients not seeking medical attention for abnormal bleeding, a reluctance of clinicians to perform dilatation and curettage, and difficulty in pathologic interpretation of the curettings. The interpretive problems related to extremely small volumes of tumor, difficulty in distinguishing carcinoma from menstrual endometrium, and difficulty in determining whether a carcinoma was endometrial rather or endocervical in origin. The tumors were aggressive, manifest by their high grade and stage. The importance of these cases is to impress upon clinicians and pathologists that endometrial carcinoma may occur in young women without any of the usual risk factors.