BACKGROUND:Although intrauterine device (IUD) usage has not been linked to uterine cancer and has even been considered protective against neoplasia, sporadic cases of IUD-associated uterine malignancies have been reported. CASES:One cystic low grade stromal sarcoma of the uterus occurred in a 7-year IUD user, and 1 invasive endometrial squamous cell carcinoma following 25 years of IUD retention occurred in another. The latter case was notable for extensive in situ squamous cell carcinoma involving the entire uterine cavity and extending to the ectocervix and into both fallopian tubes. In situ hybridization for high-risk HPV DNA was negative. These findings raise the possibility of a non-HPV-related pathway for the squamous cell carcinoma case due possibly to prolonged chronic irritation and pyometra. CONCLUSION:The association of low grade stromal sarcoma with the IUD in the first case is extremely rare and most likely coincidental. The squamous carcinoma case, however, may have arisen via a non-HPV-related pathway, possibly related to IUD-induced chronic irritation and pyometra.

译文

背景:尽管子宫内节育器(IUD)的使用并未与子宫癌相关,甚至被认为可以预防肿瘤,但已有零星的宫内节育器相关子宫恶性病例报道。
病例:7年的宫内节育器使用者发生了1例子宫囊性低度间质性肉瘤,而宫内节育器保留25年后发生了1例浸润性子宫内膜鳞状细胞癌。后一种情况是广泛的原位鳞状细胞癌,累及整个子宫腔,并延伸至子宫颈并进入两个输卵管。高危HPV DNA的原位杂交为阴性。这些发现增加了鳞状细胞癌病例与人乳头瘤病毒无关的途径的可能性,这可能是由于长期的慢性刺激和脓毒症所致。
结论:在首例情况下,低度间质肉瘤与宫内节育器的关联非常罕见,并且很可能是偶然的。但是,鳞状细胞癌病例可能是通过非HPV相关途径引起的,可能与IUD引起的慢性刺激和脓毒症有关。

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