Bangalore: Aster RV Hospital has managed a complex case involving a 56-year-old morbidly obese, nulligravida, postmenopausal woman who presented with recurrent heavy vaginal bleeding for a year. The patient, weighing 141.6 kg and with a history of hypertension and prediabetes, reported bleeding every two months lasting up to twelve days, often accompanied by pain and clot passage. Her clinical evaluation revealed fair general condition and stable vital signs, but significant physical limitations were attributed to her obesity.
Initial imaging with MRI in 2024 identified an endometrial polyp protruding through the OS. Subsequent histopathology following endometrial curettage confirmed moderately differentiated endometrioid carcinoma. Immunohistochemistry demonstrated estrogen and progesterone receptor positivity, wild type p53, and loss of MLH1 and PMS2, raising suspicion for Lynch syndrome. Advanced diagnostic imaging with a PET scan suggested increased FDG uptake in the uterus and suspected right hemi pelvic nodal metastasis, along with indeterminate lung nodules.
Dr. Smrithi D Nayak, Consultant – Obstetrics & Gynecology said “The patient underwent dilation and curettage followed by laparoscopic radical hysterectomy with peritonectomy and omentectomy on May 22, 2025, where intraoperative findings included an enlarged uterus, left ovarian cyst, dense adhesions, and retroperitoneal lymphadenopathy. Postoperative recovery was uneventful except for transient loose stools, successfully managed during her SICU stay. The final histopathology confirmed FIGO Stage IA, grade 2 endometrioid carcinoma with 29 per cent myometrial invasion, lymphovascular invasion, and negative surgical margins. All lymph nodes sampled were uninvolved by disease.”
Given her morbid obesity, laparoscopic surgery provided multiple advantages, including reduced surgical morbidity, improved intraoperative visualization, faster postoperative recovery, and shorter hospital stay. Sleep apnea screening was also initiated postoperatively. The finding of mismatch repair deficiency (MLH1/PMS2 loss) prompted further evaluation for Lynch syndrome, highlighting the importance of genetic counselling and molecular testing in endometrial cancer cases. The patient was discharged in stable condition and has been advised ongoing surveillance and preventive strategies considering both her metabolic risk profile and oncologic prognosis.
Dr. Smrithi D Nayak further stated “This case demonstrates the importance of individualized care and multidisciplinary management when treating endometrial cancer in patients with significant comorbidities. Early diagnosis, tailored surgical approaches, and attention to genetic factors like mismatch repair deficiency allow us to optimize outcomes and long-term follow-up.
