Patient Receives Delayed Uterine Cancer Diagnosis Following Misread Hysteroscopy

Case Overview

This case involves an overweight middle-aged female patient who was diagnosed with an endometrial polyp following a hysteroscopy. She presented to an OB/GYN for a second opinion regarding treatment options. The OB/GYN discussed hysterectomy versus hormonal treatment but the patient chose to undergo a total abdominal hysterectomy. During the procedure, the surgeon realized the uterus had grown too large to be removed from the vagina. It was decided that the uterus would be removed in pieces through an abdominal incision. Surgical pathology later revealed the patient had stage II endometrial cancer. When the patient asked how she could have cancer, the surgeon informed her the physician who performed the hysteroscopy had missed a polyp. Following her surgery, the patient had persistent abdominal pain and was referred for an abdominal CT. The scan showed several masses at the abdominal incision site and a CT-guided biopsy revealed metastatic adenocarcinoma. It was alleged that the tumors were of gynecological origin with endometrial histology. The patient underwent chemotherapy and many sessions of radiation therapy but continues to suffer from recurring fluid collections. An expert in gynecological oncology was sought to discuss how hysterectomies can lead to metastasis.

Questions to the Gynecology expert and their responses

How often do you perform hysterectomies?

I currently perform approximately 100 hysterectomies via various approaches per year including abdominal, laparoscopic and robotic.

Can the type of approach to a hysterectomy eventually lead to metastasis? Please elaborate.

Had the patient had a pre-operative diagnosis of cancer (i.e. if the polyp were removed pre-op), then she should not have undergone a surgery requiring morcellation of her uterus as this would be strictly contra-indicated. Given the size of her uterus, she should have either had an open hysterectomy (a TAH/BSO) or had the uterus morcellated within a containment bag. There is every reason to believe that the morcellation of the uterus caused the spread of her cancer. The fact that it recurred within the abdominal wall is extremely suggestive that the morcellation of the uterus caused the recurrence and metastases.

How does a delay in cancer diagnosis affect the prognosis of a patient? How does a delay in diagnosis have an effect on metastasis?

The real issue is that she had undiagnosed postmenopausal bleeding and therefore underwent a laparoscopic hysterectomy with morcellation which was inappropriate. According to the narrative, she appears to have had a Stage II grade 1 endometrial cancer which should not have recurred the way that it did.

About the expert

This expert has over 20 years of experience in the field of gynecologic oncology. He earned his BS from the State University of New York at Albany, followed by his MS and MD from New York Medical College. He completed his residency in obstetrics and gynecology at Baystate Medical Center and his fellowship in gynecologic oncology at the University of Minnesota. Today, this expert is board certified in obstetrics and gynecology and gynecologic oncology and is an active member of the Society of Gynecologic Oncologists. He has published 23 peer-reviewed publications, and 8 book chapters, and has been invited to deliver numerous lectures and presentations. He previously held the position of assistant, adjunct, and associate professor of obstetrics and gynecology at numerous well-known universities. Additionally, he was both the section director and associate director of gynecologic oncology at Washington Hospital Center, as well as a physician of gynecologic oncology at the University of Minnesota. Currently, he serves as a physician at a cancer care institute, an associate professor of obstetrics and gynecology at a university, and the section director of gynecologic oncology at a university-affiliated hospital, all located in Connecticut.

E-207325

Specialties:

Gynecology