Endometrial cancer recurrence presenting as anterior abdominal wall necrotising fasciitis

Endometrial cancer is the second leading cause of malignancy in women worldwide. Risk of recurrence and treatment depends on tumour grade, stage and more recently, molecular classification. This case details an atypical presentation of endometrial cancer recurrence. A postmenopausal woman presented to hospital in septic shock with anterior abdominal wall necrotising fasciitis. She was 5 years into her surveillance for FIGO (International Federation of Gynaecology and Obstetrics) Grade III, Stage IIIA mixed endometrioid and clear cell endometrial adenocarcinoma, treated by total abdominal hysterectomy, bilateral salpingo-oophorectomy, vaginal brachytherapy, radiotherapy and chemotherapy. Necrotising fasciitis was localised to a fluid collection associated with biological mesh on the anterior abdominal wall. Histopathology and cytology of the fluid collection revealed high-grade serous endometrial carcinoma. Recurrence in the incision has previously been described in the literature, however not as a fluid collection in association with biological mesh nor causing necrotising fasciitis of the anterior abdominal wall.