Hematometra and hematosalpinx as complications of advanced endometrial carcinoma
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
Acute CT scan
The uterus is distended by the known endometrial carcinoma. There is also hematometra.
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 hematometra and the development of left-sided hematosalpinx.
CT 2 mth prior
Diffusely infiltrating endometrial tumor with invasion of the left lateral fundus, isthmus of the left fallopian tube and also the cervical stroma.
2mth pre acute presentation
Diffusely infiltrating endometrial tumor 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 postmenopausal bleeding. Her staging scan showed a diffusely infiltrative endometrial tumor extending to the serosa at the left lateral fundus and invading the cervical stroma. Initial tumor staging was FIGO stage II. The patient was due to start palliative chemo-radiotherapy.
In the post-menopausal patient, hematometra develops in the setting of cervical stenosis usually caused by either normal aging, post-radiotherapy fibrosis or tumor involvement of the endometrium or cervix 1. In this case, the friable endometrial tumor had infiltrated the uterine cervix.
Hematosalpinx can be seen in untreated cervical stenosis where tumor debris and blood reflux from the uterus and distend the fallopian tube 2. In this case of advanced endometrial carcinoma, hematosalpinx developed due to tumor infiltration of the serosal layer of the left lateral fundus with involvement of the isthmus of the left fallopian tube.
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