Abstract

Background: Non-puerperal uterine inversion (NPUI) is a rare gynecological condition, most commonly associated with benign fundal leiomyomas. Its occurrence secondary to endometrial carcinoma is exceptionally uncommon and poses significant diagnostic and management challenges due to its nonspecific clinical presentation. Case Presentation: A 75-year-old multiparous postmenopausal woman presented with excessive vaginal bleeding, a protruding vaginal mass, lower abdominal pain, fever, and urinary retention. She had previously undergone polypectomy for a prolapsing vaginal mass, the histopathological examination of which revealed Grade 1 endometrioid adenocarcinoma. Clinical examination demonstrated a longitudinal growth protruding through the cervical os with distortion of normal cervical anatomy. Ultrasonography and contrast-enhanced computed tomography suggested uterine inversion with a uterine mass occupying the vaginal canal. Following multidisciplinary evaluation and optimization, exploratory laparotomy was performed. Intraoperatively, a completely inverted uterus with inflamed cervix and enlarged pelvic lymph nodes was identified. Manual vaginal reduction was followed by radical hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy, omentectomy, and appendicectomy. Histopathological examination demonstrated well-differentiated endometrioid carcinoma (FIGO Grade 1) with greater than 50% myometrial invasion and involvement of the lower uterine segment. All lymph nodes, adnexal structures, omentum, appendix, and peritoneal cytology were negative for malignancy. The final diagnosis was FIGO Stage IB (pT1bN0) endometrioid carcinoma presenting as non-puerperal uterine inversion. Conclusion: Non-puerperal uterine inversion secondary to endometrial adenocarcinoma is an exceptionally rare clinical entity. The condition may mimic other gynecological pathologies and often presents with vaginal bleeding and a protruding vaginal mass. Early recognition through careful clinical assessment and appropriate imaging is essential for accurate diagnosis and surgical planning. This case highlights the importance of considering underlying uterine malignancy in patients presenting with atypical vaginal bleeding and uterine inversion and emphasizes the role of histopathology in guiding definitive oncologic management.

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