DIAGNOSTIC CHALLENGES OF ENDOMETRIAL CARCINOMA MIMICKING PROLAPSED LEIOMYOMA IN A VIRGIN PATIENT: A CASE REPORT

Abstrak

Introduction: Endometrial carcinoma predominantly affects postmenopausal women, yet up to 25% of cases occur in reproductive-aged individuals. Diagnostic challenges arise when patients maintain virginity status, limiting internal gynecological examination. Prolapsed or pedunculated endometrial masses may mimic benign leiomyoma, potentially leading to delayed diagnosis and suboptimal management. Case Presentation: We present a case of a 36-year-old virgin woman with chronic heavy menstrual bleeding, recurrent anemia requiring multiple transfusions, and ultrasonographic findings suggestive of submucosal leiomyoma. Internal gynecological examination was deferred due to virginity considerations. Despite medical management including GnRH agonist therapy, symptoms persisted. Laparotomy revealed a friable mass expelling porridge-like material from the uterine cavity. Histopathological examination confirmed well-differentiated endometrioid adenocarcinoma. Discussion: This case illustrates the diagnostic dilemma when endometrial carcinoma mimics benign leiomyoma in young virgin patients. Sociocultural factors limiting invasive diagnostic procedures, coupled with atypical clinical presentation, contributed to delayed definitive diagnosis. The failure of GnRH agonist therapy and unique intraoperative findings provided critical clues distinguishing malignancy from benign disease. Alternative diagnostic modalities including MRI and transrectal ultrasound should be considered earlier in such cases. Conclusion: Clinicians must maintain high suspicion for malignancy in young women with refractory abnormal uterine bleeding, even when virginity status limits diagnostic options. Adoption of non-invasive or alternative imaging modalities and comprehensive counselling regarding diagnostic procedures are essential to avoid delayed diagnosis of endometrial malignancies.