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Global Translational Medicine Late abscess complication endometrial cancer

hemorrhage requiring transfusion, 13% with ileus, and 9.7% Interventional radiology unit was consulted to obtain
with infection including 3.9% with abscess formation. a biopsy of the mass. The biopsy was anticipated to be
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People with obesity have higher risks of complications. challenging due to its proximity to major vessels, the
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It is unknown whether obesity impacts survival outcomes patient’s body habitus, and her inability to lay in the
among people with endometrial cancer. Recurrence optimal position for biopsy due to pain. In the initial
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of stage 1 endometrial cancer treatment after combined attempt, fibroadipose tissue and skeletal muscle with focal
surgery and radiation therapy is 4%; 25% of these patients acute and chronic inflammation as well as fibrosis were
experience late complications. 13 obtained, and no evidence of neoplasia was identified.
A magnetic resonance imaging (MRI) test was attempted
This case report details a rare late complication, the
description of which can assist physicians in quickly on post-admission day (PAD) 6, but the patient was too
reaching the correct diagnosis and treatment. uncomfortable to lie flat.
In the ongoing consultation, the radiation oncology
2. Case presentation unit persisted in their request for pathologic confirmation
A 55-year-old woman with a history of grade 2 stage before providing an opinion on treatment. On PAD 10,
1B endometrioid adenocarcinoma of the endometrium another biopsy was attempted but the patient was again
presented to a community emergency department unable to lie prone due to anxiety and respiratory
following a 2-week onset of left lower quadrant and groin difficulties. Abdominal entry was not possible due to
pain and left leg swelling (Table 1). Her cancer treatment abdominal obesity.
included a total abdominal hysterectomy bilateral Due to her worsening leukocytosis, which peaked at
salpingo-oophorectomy (TAHBSO) (laparoscopic 25.2 × 10 /L on PAD 5, infectious work-up was performed
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converted to open) and pelvic lymph node dissection and was negative (including urine and blood cultures and
(PLND) 1-year prior, and adjuvant external beam chest X-ray). General internal medicine unit was then
radiation therapy (EBRT) completed 9-month prior. The consulted and found no indication for antibiotics for her
pain was a constant, severe ache associated with mild isolated leukocytosis, which started to decline after PAD 5
paresthesias in her left thigh. Her past medical history without treatment.
included morbid obesity (BMI 60), insulin-dependent
type 2 diabetes with poor control, obstructive sleep Throughout this period of time, the patient continued
apnea, hypertension, non-alcoholic fatty liver disease, to suffer from severe pain that was challenging to manage
hypothyroidism, and depression. She had been surgically despite consultation with the Acute Pain Management
operated with procedures such as oncology surgery and a Service and Palliative Care unit. Higher doses of narcotics
dilation and curettage. She was nulliparous. and pregabalin are required to alleviate the intense pain;
she was confronting. She also complained of increasing
At the community emergency department, deep vein drowsiness beginning 1 week after admission. It was
thrombosis was ruled out and an outpatient computed unclear if this was related to her pain management regimen
tomography (CT) was ordered (Figure 1). One day later, or underlying pathology.
she presented to our tertiary care site with a complaint
of increasing pain. She had normal vital signs, normal A repeat CT scan on PAD 11 showed slight measurable
bilateral lower limb perfusion and strength, pain on hip growth in the mass-like soft-tissue density in the left
flexion, and a soft, non-tender abdomen. She had a mild pelvis, extending into the groin muscles. This causes new
leukocytosis (white blood cells [WBC]: 16.3 × 10 /L mild obstruction of the left ureter at the pelvic brim and
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[4.0–11.0 ×10 /L]), a slightly elevated lactate (2.3 mmol/L impending bladder invasion. While infection cannot be
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[0.5–2.2 mmol/L]), and an HbA1c of 10.7% (4.0–6.0%) entirely excluded, the growing line of findings pointed to a
(Table 2). Her hemoglobin, platelets, and creatinine levels highly potential malignant recurrence.
were normal. Ca-125 was found to be 147 units/mL, On PAD 15, she was diagnosed with cellulitis of the left
reduced from 370 units/mL at her initial cancer diagnosis. foot that was treated with cephalexin. On PAD 16, she had a
Based on the CT findings from the day prior demonstrating fever at 38.2°C, but an immediately repeated measurement
a pelvic sidewall mass, she was admitted for a presumed was found to be normal.
mass due to cancer recurrence, which was speculated to On PAD 15, the patient’s case was again reviewed at a
have compressed the left external iliac artery. Vascular multidisciplinary gynecologic oncology conference. It was
surgery assessment demonstrated non-claudication pain determined that she was ineligible for further radiation
and no ischemia, and radiation oncology-based evaluation due to the previous dose received. A decision was made to
recommended pathologic confirmation of recurrence. proceed with a treatment using carboplatin and paclitaxel

Volume 3 Issue 1 (2024) 2 https://doi.org/10.36922/gtm.2114