Complex Gynecological Case: Endometriosis with Endometrial Hyperplasia Requiring Oncology Consultation

Case at a Glance

A 27-year-old nulliparous woman presents with a complex gynecological condition involving stage 2 endometriosis, endometrial hyperplasia, and suspected PCOS following laparoscopic surgery. Patient was referred to gynecologic oncology after initial endometriosis specialist consultation due to concerns about the hyperplasia findings.

Patient's Story

The patient underwent laparoscopic surgery in February revealing extensive stage 2 endometriosis affecting the bowel, bladder, and throughout the abdomen. Additional findings included a non-functioning fallopian tube, ovarian cyst, and multiple uterine masses. Endometrial biopsy demonstrated hyperplasia, and recent ultrasound suggested possible PCOS. The patient reports intolerance to multiple hormonal contraceptives and experiences severe pelvic pain that has worsened post-operatively, with new-onset right lower quadrant pain and intermittent sharp stabbing sensations, particularly when sitting.

Initial Assessment

Post-laparoscopic findings: Stage 2 endometriosis with widespread pelvic involvement, endometrial hyperplasia on biopsy, ovarian cyst, uterine masses, non-functioning fallopian tube, and suspected PCOS. Patient experiences debilitating pelvic pain with recent worsening and new pain patterns. History of hormonal contraceptive intolerance.

The Diagnostic Journey

Following consultation with an endometriosis specialist, initial management included YAZ prescription and physical therapy recommendation. However, after detailed review of pathology results with a colleague, the specialist became concerned about the endometrial hyperplasia findings and immediately referred the patient to gynecologic oncology for further evaluation and management decisions.

Final Diagnosis

Pending gynecologic oncology evaluation. Current diagnoses include: Stage 2 endometriosis with extensive pelvic involvement, endometrial hyperplasia (subtype and risk stratification pending oncology review), suspected PCOS, and chronic pelvic pain syndrome.

Treatment Plan

Immediate referral to gynecologic oncology for specialized evaluation of endometrial hyperplasia and risk assessment. Current hormonal treatment discontinued pending oncology consultation. Physical therapy initiated for pain management. Consideration for repeat laparoscopic surgery if no improvement within 3 months, though surgical risks require careful evaluation given patient's complex presentation.

Outcome and Follow-up

Patient scheduled for gynecologic oncology consultation within 1-2 business days. Treatment plan will be determined based on oncology assessment of hyperplasia risk factors and overall clinical picture. Long-term management may require multidisciplinary approach given the complexity of concurrent conditions and patient's hormonal intolerance.