EP20.07: Demystifying the dilemma: cancer or not? CEUS sheds light!

Necrotising granulomatous endometritis (NGE) is an uncommon inflammatory disorder of the uterine lining, and can mimic endometrial carcinoma or endometritis on PET CT imaging, and other conditions like adenomyosis when considering biochemical findings. A 53-year-old female underwent surgery for cholangiocarcinoma 3 years ago followed by chemotherapy and radiotherapy. During a routine PET CT follow-up, increased endometrial uptake was observed, prompting referral for gynecological evaluation. However, she was lost to follow-up. 5 months later, she presented with worsening symptoms related to biliary stricture. PET CT now revealed increased FDG avid endometrial lining and elevated CA125 levels. Pelvic ultrasound showed a retroverted uterus with fluid-fluid level and irregularities in the endometrial lining, corresponding to the PET CT findings and internal vascularity. Contrast-enhanced ultrasound revealed uniform enhancement at the endometrial-myometrial junction and no washout on the delayed images. Total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed. Histopathology confirmed extensive necrotising granulomatous endometritis, adenomyosis, and bilateral chronic necrotising granulomatous salpingo-oophoritis. In conclusion, NGE, although rare, presents a diagnostic challenge and accurate diagnosis is crucial for effective management. Contrast-enhanced ultrasound (CEUS) is a valuable imaging modality in distinguishing inflammatory or benign conditions from their mimickers- especially malignancies, offering advantages particularly in low- and middle-income countries. CEUS is safe, inexpensive, and provides real-time assessment at the bedside, helping guide further cross-sectional imaging and surgery in the right direction. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.