The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guidelines as recommendation for practice for the UK.

Case reportA 59 year old nulliparous woman presented with a two year history of irregular vaginal bleeding. She was not taking hormone replacement therapy. She was found to have an abdominopelvic mass and ultrasound con®rmed an enlarged uterus, measuring 16x13cm with the appearance of multiple ®broids. There was also gross endometrial thickening of 5cm and a loculated cystic adnexal mass measuring 13cm in diameter. Laboratory investigations revealed iron de®ciency anaemia (Hb 5.5 g/dL, MCV 54.0¯, MCH 15.8 pg) and elevated serum CA125 (115 U/L). There was also biochemical evidence of abnormal oestrogen secretion. Serum oestrogen levels (156 pmol/L) were in the premenopausal range and gonadotrophin secretion was suppressed (FSH 1.5 iu/L, LH 6.3 iu/L). Serum electrolytes and liver function tests were normal as was a chest X-ray.Four units of blood were transfused prior to undertaking a laparotomy. A midline incision was performed. A grossly enlarged uterus containing several large intramural nodules, right ovarian cyst measuring 20cm in diameter and a left ovarian cyst, 3 cm in diameter, were found ( Fig. 1). There was a small amount of clear ascites. On opening the retroperitoneum the appearance was of bilateral parametrial and pelvic side wall lymph node masses, the largest measuring 10cm and ®lling the left obturator fossa (Fig. 2). The omentum, peritoneal surfaces and upper abdomen appeared normal. Total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy and infracolic omentectomy were performed. It was possible to develop a plane around the nodal masses in the parametrium and on the pelvic side wall such that there was no remaining macroscopic tumour at the conclusion of surgery. Operative blood loss was 3000ml and a further six units of blood were transfused. Post-operatively she developed a mild degree of disseminated intravascular coagulation which was corrected with fresh frozen plasma. She became hypoproteinaemic with a protracted ileus and required intravenous nutritional support. She was discharged on the 16 th day after her operation. Histological examinationThe ascitic¯uid contained reactive mesothelial cells only. There were three separate pathologies. The larger ovarian mass of 30cm diameter was a benign ovarian ®brothecoma (Fig. 3) containing multiple degenerative pseudocysts and one small nodule of smooth muscle proliferation (Fig. 4). There was severe atypical hyperplasia of the endometrium with polyp formation (Fig. 5). The myometrium was in®ltrated by well-de®ned smooth muscle nodules, con®rmed by immunohistochemical stains for desmin. They contained no more than four mitoses per high power ®eld, and there was no evidence of vascular invasion. Similar smaller lesions were identi®ed in nodules from the left parametrium, left pelvic lymph node and right pelvic mass. The extrauterine pelvic masses contained normal lymphoid tissue as well as smooth muscle (Fig. 6). The greater omentum, which appeared normal to the naked eye, also contained microscopic smooth muscle nodu...

Case reportA 59 year old nulliparous woman presented with a two year history of irregular vaginal bleeding. She was not taking hormone replacement therapy. She was found to have an abdominopelvic mass and ultrasound con®rmed an enlarged uterus, measuring 16x13cm with the appearance of multiple ®broids. There was also gross endometrial thickening of 5cm and a loculated cystic adnexal mass measuring 13cm in diameter. Laboratory investigations revealed iron de®ciency anaemia (Hb 5.5 g/dL, MCV 54.0¯, MCH 15.8 pg) and elevated serum CA125 (115 U/L). There was also biochemical evidence of abnormal oestrogen secretion. Serum oestrogen levels (156 pmol/L) were in the premenopausal range and gonadotrophin secretion was suppressed (FSH 1.5 iu/L, LH 6.3 iu/L). Serum electrolytes and liver function tests were normal as was a chest X-ray.Four units of blood were transfused prior to undertaking a laparotomy. A midline incision was performed. A grossly enlarged uterus containing several large intramural nodules, right ovarian cyst measuring 20cm in diameter and a left ovarian cyst, 3 cm in diameter, were found ( Fig. 1). There was a small amount of clear ascites. On opening the retroperitoneum the appearance was of bilateral parametrial and pelvic side wall lymph node masses, the largest measuring 10cm and ®lling the left obturator fossa (Fig. 2). The omentum, peritoneal surfaces and upper abdomen appeared normal. Total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy and infracolic omentectomy were performed. It was possible to develop a plane around the nodal masses in the parametrium and on the pelvic side wall such that there was no remaining macroscopic tumour at the conclusion of surgery. Operative blood loss was 3000ml and a further six units of blood were transfused.Post-operatively she developed a mild degree of disseminated intravascular coagulation which was corrected with fresh frozen plasma. She became hypoproteinaemic with a protracted ileus and required intravenous nutritional support. She was discharged on the 16 th day after her operation. Histological examinationThe ascitic¯uid contained reactive mesothelial cells only. There were three separate pathologies. The larger ovarian mass of 30cm diameter was a benign ovarian ®brothecoma (Fig. 3) containing multiple degenerative pseudocysts and one small nodule of smooth muscle proliferation (Fig. 4). There was severe atypical hyperplasia of the endometrium with polyp formation (Fig. 5). The myometrium was in®ltrated by well-de®ned smooth muscle nodules, con®rmed by immunohistochemical stains for desmin. They contained no more than four mitoses per high power ®eld, and there was no evidence of vascular invasion. Similar smaller lesions were identi-®ed in nodules from the left parametrium, left pelvic lymph node and right pelvic mass. The extrauterine pelvic masses contained normal lymphoid tissue as well as smooth muscle (Fig. 6). The greater omentum, which appeared normal to the naked eye, also contained microscopic smooth muscle nodul...