A Rare Case of Uterine Serous Carcinoma: Importance of Early Detection and Comprehensive Treatment in Postmenopausal Women.

Abstract

Introduction: Uterine serous carcinoma (USC) is an uncommon but highly aggressive subtype of endometrial cancer, constituting approximately 10% of all endometrial carcinoma cases. Due to its aggressive nature, it is often diagnosed at an advanced stage, with a significant proportion of patients presenting with metastasis.

Case presentation: This report deals with a case of a 75-year-old postmenopausal female with a history of obesity and hypertension, presenting with abnormal vaginal bleeding over 2 years. Her obstetric history included three cesarean sections, and she had not undergone a speculum examination for 35 years. Transvaginal ultrasound revealed a heterogeneous structure with cystic changes nearly filling the uterine cavity, suggestive of an intrauterine polyp. Dilation and curettage under general anesthesia disclosed that the uterine cavity is filled with gray, soft endometrial material. Histopathological examination confirmed the diagnosis of serous papillary carcinoma of the endometrium. Subsequent imaging was unremarkable for distal metastasis. The patient underwent an abdominal total hysterectomy with bilateral adnexectomy and pelvic lymphonodectomy. Histopathology indicated high-grade papillary serous adenocarcinoma with minimal myometrial invasion and metastasis in 3 out of 10 regional lymph nodes. Postoperatively, she received 25 sessions of radiotherapy and four doses of chemotherapy with paclitaxel and carboplatin. Nine months post-surgery, the patient remains in good health and adheres to a strict monitoring protocol. This case emphasizes the necessity of comprehensive diagnostic evaluations and aggressive treatment in postmenopausal women presenting with vaginal bleeding.

Conclusion: Despite its typically poor prognosis, early diagnosis and treatment of USC can lead to favorable outcomes. This case underscores the importance of timely intervention in managing postmenopausal vaginal bleeding, particularly in the context of potential malignancies.