This is the most unusual and bizarre cancer case I have ever seen.

69 year old female with no previous medical history presented to her gynecologist with vaginal bleeding. Pelvic ultrasound reveled an abnormal endometrial thickening. Endometrial biopsy confirmed the diagnosis of endometrial cancer.

The patient underwent uneventful laparoscopic hysterectomy and salpingo-oophorectomy. The post-op pathology revealed a surprise – in addition to the endometrial cancer the patient also had grade 1 ovarian papillary serous carcinoma.

A PET scan revealed areas of increased intake in the pelvis. Very shortly after the first surgery she underwent exploratory laparotomy and restaging including pelvic/periaortic lymphadenectomy, omentectomy and multiple biopsies. The final pathology – no cancer, just reactive changes after the first procedure.

Five weeks later the patient gets readmitted with abdominal distention and a sepsis like picture. CT abdomen/pelvis showed multiple abdominal and pelvic masses. CT chest shows multiple pulmonary nodules (see the images above). Broad spectrum IV antibiotics started. The patient was getting progressively worse.

The biggest question was: what were we dealing with? It would be unlikely for stage 1 endometrial or ovarian cancer to progress so rapidly just a few weeks after a complete restaging.

Some reports in the medical literature indicate that a laparoscopic approach for hysterectomy could promote retrograde dissemination of the cancer cells through the fallopian tubes into the peritoneal cavity. These concerns were not substantiated in the bigger studies.

The patient was taken back to OR for an exploratory laparotomy. Intraoperative findings – abdomen and pelvis are packed with cancer. The preliminary pathology – high grade sarcoma. The biopsy specimens were sent to New York to a sarcoma specialist.

The patient continued to deteriorate and Hospice care was initiated.

All the pathology slides beginning with the first surgery are going to be re-looked at and reviewed again. Regardless of what the final pathological diagnosis is, this is the most explosive presentation of cancer I have ever seen.