Haematometra and haematosalpinx as complications of advanced endometrial carcinoma

Case contributed by Dr Sophie O'Dowd

Presentation

Patient presents to the Emergency Department with severe abdominopelvic pain, PV bleeding, vomiting and sepsis on a background of known endometrial carcinoma.

Patient Data

Age: 66
Gender: Female

The uterus is distended by the known endometrial carcinoma. There is also haematometra. 

A relatively low attenuation left adnexal lesion is evident and cannot be separated from the left fallopian tube (as best depicted on the coronal images). The lesion is dilated and tubular in shape and has the attenuation value of complex fluid (average HU 35). 

Overall appearances represent endometrial carcinoma complicated by haematometra and the development of left-sided haematosalpinx. 

Staging CT 2 months prior to the acute presentation

Modality: CT

Diffusely infiltrating endometrial tumour with invasion of the left lateral fundus, isthmus of the left fallopian tube and also the cervical stroma. 

Staging MRI 2 months prior to the acute presentation

Modality: MRI

Diffusely infiltrating endometrial tumour with invasion of the left lateral fundus, isthmus of the left fallopian tube and also the cervical stroma. Fibroids are also noted. 

Case Discussion

The patient had presented 3 months earlier with post menopausal bleeding. Her staging scan showed a diffusely infiltrative endometrial tumour extending to the serosa at the left lateral fundus and invading the cervical stroma. Initial tumour staging was FIGO stage II. The patient was due to start palliative chemo-radiotherapy.

In the post-menopausal patient, haematometra develops in the setting of cervical stenosis usually caused by either normal ageing, post-radiotherapy fibrosis or tumour involvement of the endometrium or cervix [1].  In this case the friable endometrial tumour had infiltrated the uterine cervix. 

Haematosalpinx can be seen in untreated cervical stenosis where tumour debris and blood reflux from the uterus and distend the fallopian tube [2]. In this case of advanced endometrial carcinoma, haematosalpinx developed due to tumour infiltration of the serosal layer of the left lateral fundus with involvement of the isthmus of the left fallopian tube. 

 

 

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Case Information

rID: 41069
Case created: 14th Nov 2015
Last edited: 16th Aug 2016
System: Gynaecology
Inclusion in quiz mode: Included

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