Endometrial Cancer: Hidden Pathology in a Patient with Abnormal Uterine Bleeding and Known Leiomyoma

Abstract

Uterine leiomyomas and endometrial pathology are both associated with abnormal uterine bleeding. We report a case in which a nulliparous woman with heavy uterine bleeding and leiomyomas had undergone two prior hysteroscopic myomectomies for benign leiomyomas. She was evaluated, but was ineligible for a clinical trial of a novel Magnetic Resonance guided High Intensity Focused Ultrasound (MRgx200B;HIFU) device. The 8 cm, prolapsed submucosal leiomyoma hindered endometrial sampling and was inaccessible to HIFU treatment. Preoperatively, neither endometrial sampling nor saline sonohysterography was technically feasible. She underwent hysterectomy, and on histological examination of specimen, stage 1A grade 1 endometrial carcinoma was found on the endometrial side of the prolapsing fibroid. Endometrial pathology is an important consideration in the evaluation of abnormal uterine bleeding, even in women with large prolapsing leiomyoma.

Trial registration: ClinicalTrials.gov NCT00837161.

© 2015 S. Karger AG, Basel.

Figures

Figure 1A

Transvaginal ultrasound image of the uterus in the sagittal plane, arrow demonstrating a large pedunculated leiomyoma.

Figure 1B

T-2 Fat saturated MR image of the pelvis in the coronal plane, arrow demonstrating a large pedunculated submucosal leiomyoma prolapsing into the cervical canal and upper vagina

Figure 1C

T-2 Fat saturated MR image of the pelvis in the sagittal plane, arrow demonstrating the prolapsing submucosal leiomyoma