Fertility‐Sparing Management of Grade 2 Endometrioid Endometrial Adenocarcinoma Without Progesterone Receptor Expression: A Case Report

Managing G2 endometrioid endometrial adenocarcinoma without progesterone receptor (PR) expression presents significant challenges, particularly when considering fertility preservation. Grade 2 tumors fall into an area of uncertainty within fertility‐sparing strategies, making treatment decisions complex and requiring careful individualization. This case report describes a 41‐year‐old patient who, despite PR and PE negativity, responded to conservative management with hysteroscopic resection, a levonorgestrel‐releasing intrauterine device, metformin, and later megestrol, achieving complete histological remission in 15 months. The difficulty in managing G2 tumors lies in their variable behavior, necessitating a multidisciplinary approach, strict monitoring, and adaptability based on treatment response. This case underscores that, although fertility preservation in PR‐negative G2 tumors remains challenging, it is feasible in highly selected cases. The evolving literature suggests that alternative strategies, such as immune modulation and aromatase inhibitors, may further expand options. Individualized management remains crucial, balancing oncological safety with reproductive goals through continuous reassessment and engagement with emerging therapeutic evidence.