Missed hysteroscopic detection of uterine carcinoma before endometrial resection: report of three cases

Endometrial ablation or resection using hysteroscopy appears to be an effective treatment for menorrhagia resistant to medical therapy. Three patients with endometrial adenocarcinoma missed in the preoperative hysteroscopic and histological assessment and subjected to endometrial resection were collected in a multicenter study. One case was an early adenocarcinoma in the background of late proliferative endometrium in a 39-year-old woman. In the other two patients, ages 51 and 68, the adenocarcinoma developed in a polyp in a background of simple hyperplasia. Since hysteroscopy with endometrial biopsy might not be able to exclude the presence of an early intrauterine cancer, appropriate selection and accurate evaluation of patients are imperative before ablative surgery. Endometrial resection is preferred over endometrial laser ablation since it provides additional tissue for histologic examination.