Adenocarcinoma diagnosed at endometrial ablation

Area of Science:

• Gynecologic surgery
• Oncology
• Pathology

Background:

• Endometrial ablation is a common surgical treatment for abnormal uterine bleeding.
• Occult endometrial adenocarcinoma can be missed during ablation, particularly with destructive methods.
• Hysterectomy remains an alternative, but endometrial ablation is preferred by many patients.

Observation:

• A 41-year-old woman with menorrhagia underwent endometrial ablation after investigations for dysfunctional uterine bleeding were negative.
• Pre-ablation dilation and curettage revealed benign endometrium.
• Pathologic examination of the resected endometrium post-ablation unexpectedly revealed focal, well-differentiated endometrial adenocarcinoma.

Findings:

• Endometrial ablation, especially using destructive techniques, poses a risk of failing to detect occult endometrial cancer.
• Resective endometrial ablation techniques offer superior tissue for histopathologic evaluation compared to destructive methods.
• This case highlights a missed diagnosis of endometrial cancer in a patient undergoing ablation for presumed benign conditions.

Implications:

• Patient selection and thorough pre-operative evaluation are critical before endometrial ablation.
• Resective techniques for endometrial ablation are recommended to ensure adequate tissue for pathological diagnosis.
• Close postoperative surveillance is essential for patients who have undergone endometrial ablation to detect any missed malignancies.