Endometrial Carcinoma Mimicking Ovarian Tumor

Abstract

Purpose

Endometrial cancer in postmenopausal women most commonly presents with vaginal bleeding. Rarely, cervical stenosis may lead to collection of blood inside the uterus leading to hematometra. Due to the absence of vaginal bleeding, the diagnosis is often late and may present as abdominopelvic mass. Large pelvic masses have heterogeneous origins and vague clinical features. Imaging is of assistance in some of the subjects, but it sometimes cannot determine the origin of the mass. A huge hematometra may present as a pelvic tumor.

Case

A 60-year-old multiparous postmenopausal woman presented with a large abdominopelvic mass. After investigations, the woman underwent a staging laparotomy with a provisional diagnosis of a malignant ovarian tumor. Per operatively, it was discovered to be an enlarged uterus due to hematometra. Bilateral tubes and ovaries were normal. Total abdominal hysterectomy with bilateral sal**o-oophorectomy and pelvic lymphadenectomy was done. Histopathology revealed poorly differentiated endometrial carcinoma, Stage 1A. Autolysis of cells was seen on histopathology.

Conclusion

We conclude that diagnosis of endometrial cancer should always be kept in mind in postmenopausal women presenting with hematometra. Cervical stenosis may be seen in patients without any prior cervical surgery as seen in this case. Autolysis of cells of the specimen may have been due to prolonged exposure of the endometrium to the blood. Proper preservation of the specimen should be ensured to avoid autolysis due to inadequate preservation technique.