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

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.

Keywords: ankle fracture; endometrial carcinoma; severe anemia.