Pyometrium as an Early Indicator of Cervical Squamous Cell Carcinoma: A Systematic Review

Abstract

We present the case of an 81-year-old G5P5 Caucasian female who presented to the emergency room for lower abdominal pain, bloating, and green-colored vaginal discharge for the past 3 weeks. A computed tomography of the abdomen and pelvis showed markedly distended endometrial cavity containing fluid and small air bubble concerning for cervical stenosis verses endometrial neoplasm/ endometritis suggestive of pyometra. Dilation and curettage was performed with endometrial curette, of which pathology revealed endometritis and detached fragments of squamous cell carcinoma, which showed positive staining with p16, p63, and high Ki67, which is consistent with cervical HPV-related squamous cell carcinoma. The endometrial tissue seen was negative for malignancy. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy and pelvic/para-aortic lymph node dissection, and postoperative recovery was complicated by postoperative ileus which led to a small bowel obstruction. Pyometrium is uncommon, however often presents in postpartum or postmenopausal women and has an 80% association with malignancy. After thorough review of 80 case reports of women with pyometrium, we highlight the importance of considering gynecological malignancy as an underlying cause of pyometra in postmenopausal women, and the importance of early diagnosis in attempt to decrease rates of spontaneous per-forated pyometra.