Introduction/Background Eighty-five percent of uterine inversions are puerperal. Nonpuerperal uterine inversion is usually precipitated by tumors exerting a pulling force on the fundus of the uterus, causing the uterus to turn partially or completely upside down. It is most often associated with benign tumors such as submucosal leiomyomas. However, malignancies are a rare association.
Results Mrs. MS aged of 35, gravida0 para0, whoconsulted for menometrorrhagia associated with pelvic pain since 2 years.
On examination, patient was hemodynamically stable, afebrile, with pale conjunctivae and a uterus increased in size .
A transvaginal Ultrasonography was not realized because the patient declared to be virgin.
A suprapubic Ultrasound showed an enlarged globulous uterus with heterogenous indefinite mass of 49 mm.
A malignant tumor was suspected and a pelvic magnetic resonance imaging (MRI) scan was performed.
It showed the appearance of U-shaped uterine cavity and a thickened inverted uterine fundus on a sagittal image and a ‘bulls-eye’ configuration on an axial image.
The uterus was the site of an endometrial infiltrating mass of 25 mm, with high T2 signal, hyperintense on diffusion-weighted sequence with low apparent diffusion coefficient (ADC), heterogeneously enhanced after gadolinium injection. Few spots of spontaneous high T1 signal were present related to heamorrhagic areas.
There was no intraperitoneal effusion. The conclusion was a uterine inversion on an infiltrating endometrial mass.
Per-operative exploration showed uterine inversion taking away the ovaries; the fallopian tubes and the round ligaments. A vertical hysterotomy of the posterior surface of the uterus allowed excision of a friable necrotic intracavitary mass.
The surgical specimen was sent for extemporaneous anatomo-pathological examination showing undifferentiated tumor proliferation.
This was completed by surgical release of the constriction ring and manual reduction of the uterine inversion and then hysteroraphy .
The anatomo-pathological examination confirmed the malignancy: Adenosarcoma.
The patient recovered from the operation without complications and was referred to an oncologist for further treatment.
Disclosures Uterine inversion rarely occurs outside of the puerperal period. The fear is to miss a malignant etiology. Hence the importance of comprehensive care with a meticulous etiological investigation .
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