Endometrial cancer detected unusually after an ankle fracture secondary to severe anemia in an obese woman with heavy menstrual bleeding: A case report

Yoon,Hyung Joon; Go,Tae Sik; Kim,Kyung Bin; Song,Yong Jung; Suh,Dong Soo; Kim,Ki Hyung

doi:10.3892/mco.2024.2802

Endometrial cancer detected unusually after an ankle fracture secondary to severe anemia in an obese woman with heavy menstrual bleeding: A case report

Authors:
- Hyung Joon Yoon
- Tae Sik Go
- Kyung Bin Kim
- Yong Jung Song
- Dong Soo Suh
- Ki Hyung Kim
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Affiliations: Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan 49241, Republic of Korea, Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan 49241, Republic of Korea, Department of Pathology, Pusan National University School of Medicine, Busan 49241, Republic of Korea
Published online on: November 6, 2024 https://doi.org/10.3892/mco.2024.2802
Article Number: 7
Copyright: © Yoon et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Endometrial cancer (EC) is a growing public health concern in developed countries. The incidence of EC is increasing, particularly in younger women (aged <50 years). Ankle fractures are relatively common orthopedic injuries, with the most common mechanisms being falls or trauma. A 36‑year‑old woman presented to the emergency department with right ankle pain secondary to a fall caused by dizziness and headache after menstruation. Initial radiography reveled a right ankle fracture without dislocation. Initial laboratory results revealed a hemoglobin level of 4.9 g/dl. She had a recent history of menorrhagia that lasted for two years. The body mass index was 36.2 kg/m². During the evaluation, she was referred to the authors' gynecology unit after a computed tomography scan revealed a significant endometrial mass that was suspected to be EC. Magnetic resonance imaging revealed a 6.7‑cm‑sized endometrial mass with restricted diffusion, myometrial invasion of <1/2, and bilateral polycystic ovaries. The patient underwent open reduction and internal fixation involving screw fixation of a right ankle fracture. The postoperative follow‑up showed successful healing and functional recovery. A total of 4 weeks later, robot‑assisted total hysterectomy, bilateral salpingectomy and sentinel lymph node sampling were performed. Final histopathology revealed stage 1B, grade 2 endometrioid adenocarcinoma with lymphovascular space invasion. The patient received 50.4 Gy radiation to the whole pelvis. At 26 months of postoperative follow‑up, the patient remained disease‑free. The present case report describes a rare presentation of EC in an obese woman with heavy menstrual bleeding after ankle fracture secondary to severe anemia. The present case highlights the importance of assessing gynecological conditions through a detailed review of gynecological history with caution when an obese female patient presents with abnormal uterine bleeding, even during a non‑gynecologic assessment.

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