Endometriotic Mass After Hysterectomy in a 61 Year Old Post-menopausal Woman: A Case Report and Update

Marie Pierre Mathey, Jean Bouquet de Jolinière, Attila Major, François Pugin, Francois Pugin, Etienne Monnard, M Fiche, Maryse Fiche, Daniel Sandmeier, F. Khomsi, Fathi Khomsi, Anis Feki, Anis Féki
Frontiers in surgery · 2019 · vol. 6 , pp. 14 · doi:10.3389/fsurg.2019.00014 · PMID:31134208 · W2943957950
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 61-year-old post-menopausal woman who developed a symptomatic endometriotic pelvic mass after hysterectomy, despite no prior endometriosis diagnosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper reports a 61-year-old post-menopausal woman on hormone replacement therapy who, after prior hysterectomy without ovariectomy, presented with severe metrorrhagia and was found to have a large, highly vascular pelvic/vaginal-dome mass. Using imaging (ultrasound, CT, MRI, PET-CT) and repeated biopsies that showed endometrium without malignant features, clinicians initially considered a rare mullerian adenofibroma, partly because endometriosis was discussed but not retained due to the prior hysterectomy and the small/limited biopsy samples. After multidisciplinary review, she underwent diagnostic laparoscopy followed by removal of an infiltrated recto-sigmoid/vaginal mass, and final pathology concluded endometriosis with no malignancy (notably, the specimen did not identify vaginal mucosa/wall). This paper is centrally about endometriosis — it describes a post-hysterectomy post-menopausal endometriotic pelvic mass and the diagnostic challenge of distinguishing it from low-grade gynecologic malignancy.

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Abstract

Endometriosis is a common, hormone-dependent gynecologic disease. Undiagnosed in large proportion of women, managing therapies depend on the impact of quality of life and includes hormonal treatment and pelvic surgery. Less likely endometriosis can occur in post-menopausal women. Malignant transformation of endometriosis is a rare but well-described process, most of time occurring in the ovary, and justifies the practitioner not to underestimate this pathology. We present a case of a 61 year old woman with a symptomatic endometriotic pelvic mass, status post hysterectomy, with no history of endometriosis diagnosed beforehand.

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endometriosis

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