Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction:
Endometrial cancer is one of the most common gynecologic malignancies in women. It originates from the innermost lining of the uterus called the endometrium and is classified into either type 1, which is most common, or type 2. Type 1 comprises endometrial cancers of endometrioid origin while type 2 includes non-endometrioid origin including serous or clear cell. Risk factors contributing to type 1 involve unopposed estrogen exposure such as obesity, exogenous estrogen, estrogen-secreting tumors, chronic anovulation, tamoxifen therapy, early menarche, and late menopause. Unlike the availability of screening tests for breast, cervical, and prostate cancer, endometrial cancer is usually diagnosed in symptomatic women presenting with postmenopausal bleeding prompting an endometrial biopsy. However, there are cases where this typical patient presentation does not occur and only through elective procedures resulting in histological evaluation does endometrial cancer become diagnosed.
Case Presentation:
A 27-year-old female, G0P0, with a known diagnosis of a fibroid uterus, PCOS, and anemia status post-packed red blood cell transfusion presented to the clinic to establish care after obtaining insurance for definitive treatment for her heavy menstrual bleeding. The patient reported abnormal vaginal bleeding, menorrhagia, dyspareunia, dysmenorrhea, and pelvic pain. Physical exam notable of a BMI of 46.3, but no other abnormalities. Transvaginal ultrasound measured the uterus at 13.14 x 8.75 x 7.8 cm with a 6.2 cm uterine fundal mass. Bilateral ovaries not well visualized due to body habitus. The patient followed up for her annual gynecologic examination with a pap smear reported as benign reactive cellular changes consistent with inflammatory process. She decided to proceed with a total abdominal hysterectomy with bilateral salpingectomy. As routine protocol, the specimen was sent to pathology to rule out malignancy. Final pathology reported endometrial endometrioid adenocarcinoma, FIGO grade 2 involving less than 50% of myometrium. Right and left fallopian tube salpingectomy with benign paratubal cysts and negative for malignancy. Results discussed with patient at follow up visit and prompt referral to gynecologic oncology followed by intensive workup and definitive surgical treatment.
Conclusion:
This case presents endometrial cancer as an incidental finding via histologic evaluation due to protocol of sending specimens to pathology after elective total abdominal hysterectomy and salpingectomy. In this patient’s case, this could have been found out a year ago if the patient had consistent access to health insurance and had proceeded with definitive surgical treatment. This brings to attention the on-going discussion regarding access to healthcare, health disparities, and equity. As future physicians, our goal is to advocate for patient well-being and this case demonstrates patient autonomy who did not wish for future fertility and alleviation of debilitating symptoms. It is imperative that we focus on modifiable risk factors in relation to endometrial cancer, such as obesity. Obesity is a risk factor for many diseases that are potentially reversible such as hyperlipidemia, hypertension, and obstructive sleep apnea; however, this is not the case for endometrial cancer. Annual gynecological wellness visits and discussion of healthy lifestyle modifications incorporated with preventative screenings may potentially help diagnose such diseases early with prompt and optimal treatment.
Embargo Period
5-29-2026
Included in
Unexpected Histopathologic Diagnosis of Endometrial Endometrioid Adenocarcinoma Following Elective Hysterectomy
Moultrie, GA
Introduction:
Endometrial cancer is one of the most common gynecologic malignancies in women. It originates from the innermost lining of the uterus called the endometrium and is classified into either type 1, which is most common, or type 2. Type 1 comprises endometrial cancers of endometrioid origin while type 2 includes non-endometrioid origin including serous or clear cell. Risk factors contributing to type 1 involve unopposed estrogen exposure such as obesity, exogenous estrogen, estrogen-secreting tumors, chronic anovulation, tamoxifen therapy, early menarche, and late menopause. Unlike the availability of screening tests for breast, cervical, and prostate cancer, endometrial cancer is usually diagnosed in symptomatic women presenting with postmenopausal bleeding prompting an endometrial biopsy. However, there are cases where this typical patient presentation does not occur and only through elective procedures resulting in histological evaluation does endometrial cancer become diagnosed.
Case Presentation:
A 27-year-old female, G0P0, with a known diagnosis of a fibroid uterus, PCOS, and anemia status post-packed red blood cell transfusion presented to the clinic to establish care after obtaining insurance for definitive treatment for her heavy menstrual bleeding. The patient reported abnormal vaginal bleeding, menorrhagia, dyspareunia, dysmenorrhea, and pelvic pain. Physical exam notable of a BMI of 46.3, but no other abnormalities. Transvaginal ultrasound measured the uterus at 13.14 x 8.75 x 7.8 cm with a 6.2 cm uterine fundal mass. Bilateral ovaries not well visualized due to body habitus. The patient followed up for her annual gynecologic examination with a pap smear reported as benign reactive cellular changes consistent with inflammatory process. She decided to proceed with a total abdominal hysterectomy with bilateral salpingectomy. As routine protocol, the specimen was sent to pathology to rule out malignancy. Final pathology reported endometrial endometrioid adenocarcinoma, FIGO grade 2 involving less than 50% of myometrium. Right and left fallopian tube salpingectomy with benign paratubal cysts and negative for malignancy. Results discussed with patient at follow up visit and prompt referral to gynecologic oncology followed by intensive workup and definitive surgical treatment.
Conclusion:
This case presents endometrial cancer as an incidental finding via histologic evaluation due to protocol of sending specimens to pathology after elective total abdominal hysterectomy and salpingectomy. In this patient’s case, this could have been found out a year ago if the patient had consistent access to health insurance and had proceeded with definitive surgical treatment. This brings to attention the on-going discussion regarding access to healthcare, health disparities, and equity. As future physicians, our goal is to advocate for patient well-being and this case demonstrates patient autonomy who did not wish for future fertility and alleviation of debilitating symptoms. It is imperative that we focus on modifiable risk factors in relation to endometrial cancer, such as obesity. Obesity is a risk factor for many diseases that are potentially reversible such as hyperlipidemia, hypertension, and obstructive sleep apnea; however, this is not the case for endometrial cancer. Annual gynecological wellness visits and discussion of healthy lifestyle modifications incorporated with preventative screenings may potentially help diagnose such diseases early with prompt and optimal treatment.