Advanced clear cell carcinoma presenting as pyometra in the setting of a forgotten IUCD.

Abstract

Introduction: Pyometra is the accumulation of pus in the uterus. It is most common in post‐menopausal women with an incidence of approximately 0.2%, but can be ten times higher in those with a malignancy. Methods: I present the case of a well woman who presented to her local medical officer with purulent vaginal discharge and three weeks of lower abdominal pain (worse in right iliac fossa) with reported associated fevers and rigors in the setting of an intrauterine device that had been in situ for greater than 50 years. Investigation of this pyometra included a CT which showed omental thickening and ascites which, when sampled, showed atypical cells highly suspicious of malignancy. The patient proceeded to have an uncomplicated total abdominal hysterectomy, bilateral salpingoophorectomy and omentectomy with peritoneal washings leading to the diagnosis of an advanced clear cell carcinoma (FIGO stage IVb). Results: The presence of offensive discharge or indeed pyometra in the post‐menopausal woman should prompt detailed investigation as there is a strong association between this diagnosis and malignancy. Discussion: I discuss the clinical manifestation and management of this uncommon presentation