Small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease
Chuang, J.; Chu, C.C.; Hwang, J.L.; Cheng, W.C.
Archives of Gynecology and Obstetrics 266(3): 178-180
2002
ISSN/ISBN: 0932-0067 PMID: 12197562 DOI: 10.1007/s00404-001-0257-4Document Number: 261117
Background: Small cell carcinoma of the endometrium is a rare disease entity characterized by bulkiness and predisposition to necrosis. Clinical presentations include postmenopausal bleeding, lower abdominal mass, chronic abdominal pain and menorrhagia. We present a case of small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease. The literature is also reviewed. Case: A 64 year old female presented was admitted with the principal complaints of fever, lower abdominal pain and malodorous vaginal discharge. Bimanual examination revealed cervical motion tenderness with a WBC of 9400 cells/muL and increased levels of neutrophils, band cells and C-reactive protein. Sonography revealed an adnexal echocomplex compatible with tubo-ovarian abscess. Culture of the vaginal discharge revealed the presence of E. coli. Symptoms persisted despite three days of antibiotics administration so a laparotomy was performed with a friable hemorrhagic uterus revealed and an area of necrosis evident in the left adnexa. Malignancy was confirmed from frozen section. Total abdominal hysterectomy, with bilateral salpingo-oophorectomy and optimal debulking, was performed. The final pathology report confirmed small cell carcinoma of the endometrium. Conclusion: Malignancy and pelvic inflammatory disease have overlapping clinical characteristics. Once pelvic inflammatory disease is suspected in a postmenopausal patient, malignancy should also be suspected, and a thorough examination and a tumor-marker analysis performed.
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