Benign senile pyometra, endometrial cholesterol granulomas and adenosquamous carcinoma

Endometrial curettage of a 78-year-old patient with benign senile pyometra revealed endometrial cholesterol granulomas. Five years later cytological studies were suspicious of malignancy. Hysterectomy disclosed an endometrial adenosquamous carcinoma associated with cholesterol granulomas. We speculate that endometrial cholesterol granuloma, like endometrial xanthogranuloma, represents a rare morphologic variant of benign senile pyometra. Consequently a strong association with carcinoma is to be expected.