Endometrial adenocarcinoma arising in a pelvic implant following uterine morcellation: A case report

https://doi.org/10.1016/j.crwh.2020.e00174Get rights and content
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Highlights

  • A patient underwent a subtotal hysterectomy with morcellation for a fibroid uterus with benign pathology.

  • Eighteen years later the patient developed endometrioid cancer in a uterine pelvic deposit.

  • The patient used unopposed estrogen as hormone replacement treatment.

  • The use of unopposed estrogen hormone therapy in patients who have undergone subtotal hysterectomy or morcellation of the uterus should be discouraged due to possible risk of developing cancer in residual endometrial tissue.

Abstract

We report a unique case of a 60-year-old woman developing endometrial cancer in a uterine deposit 18 years after she had undergone laparoscopic subtotal hysterectomy with morcellation for benign pathology. She had used unopposed estrogen as menopausal hormone therapy. She presented with a pelvic mass that was causing pressure symptoms. On imaging, the mass had an enhancing vascular nodular component and appeared to abut normal ovaries and the residual cervix. She proceeded to laparotomy, where a 12 cm pelvic mass was found morbidly adherent to the bladder anteriorly and to the cervical stump. The pelvic mass was excised, and trachelectomy and bilateral salpingo-oophorectomy were performed. Adjacent to this mass was a separate, 5 cm adnexal mass, which was also excised. Histopathology of the smaller pelvic mass was consistent with endometrial adenocarcinoma grade 1, arising in complex endometrial hyperplasia with atypia surrounded by myometrium consistent with a uterine implant. This case highlights the need for consideration and discussion of possible risks of subtotal hysterectomy and morcellation of the uterus for benign disease. Furthermore, given the results in this patient, the use of unopposed estrogen in such patients is discouraged due to possible effects on any residual endometrium still present.

Keywords

Endometrial cancer
Morcellation
Menopausal hormone therapy
Case report

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