Introduction/Background Although rarely diagnosed, endometrial cancer (EC) with squamous differentiation presents unique challenges for gynecologists. Due to a lack of distinct clinical characteristics accurate diagnosis is frequently obtained after surgery and subsequent histopathological examination.

Methodology A 48-year-old obese and multimorbid woman was admitted because of postmenopausal uterine bleeding. Diagnostic curettage revealed the diagnosis of endometroid EC, G1. Biopsy of the cervix which was performed due to suspect findings at clinical examination showed tumor cells with squamous differentiation, suspicious of simultaneously occurring cervical cancer (CC) as leading and prognostically most impactful diagnosis. Preoperative imaging procedures presented no metastatic disease in the pelvic lymph nodes, but enlarged and irregularly shaped ovaries. Due to various high perioperative surgical risks, laparoscopic staging with pelvine lymphadenectomy and intraoperative frozen section was recommended, followed by laparoscopic total mesometrial resection (TMMR) in case of negative lymph nodes.

Results Laparoscopic lymphadenectomy was performed and followed by TMMR in the absence of lymph node metastases. Detailed histopathological analysis unexpectedly showed the diagnosis of EC with squamous differentiation and metastatic disease in the ovaries.

Conclusion Diverging histopathological findings and ambiguous clinical presentation led to the inaccurate diagnosis of advanced CC with simultaneous EC instead of EC with squamous differentiation. The lack of randomized clinical trials regarding optimal surgical and adjuvant treatment, as well as the lack of standardized therapeutic procedures for women with EC with squamous differentiation offer challenges for clinicians and patients.

Disclosures Conflicts of interest as stated in the attached files.