A Case Report on Multiple Fibroid Uterus with Endometrial Hyperplasia Turned To Be Endometrial Carcinoma

Abstract Endometrial carcinoma is the most common gynecologic malignancy in developed countries and ranks among the leading causes of cancer-related morbidity in women. Endometrial hyperplasia, particularly when atypical, is a recognized precursor with a malignant transformation risk as high as 45%. Uterine leiomyomas (fibroids), highly prevalent benign smooth muscle tumors, frequently present with heavy or irregular menstrual bleeding. In perimenopausal and obese women, such bleeding warrants careful endometrial assessment, as coexisting benign lesions may mask underlying malignancy.This report describes a perimenopausal woman with obesity and abnormal uterine bleeding found to have multiple fibroids with atypical endometrial hyperplasia progressing to early-stage carcinoma. Diagnosis was established through imaging and endometrial sampling, followed by definitive surgical management.This case highlights the importance of maintaining a high index of suspicion for endometrial carcinoma in women with abnormal uterine bleeding, even in the presence of fibroids. Clinical vigilance is particularly warranted in patients with risk factors such as obesity, chronic anovulation, and prolonged unopposed estrogen exposure. Literature emphasizes that perimenopausal and postmenopausal women with endometrial thickening or unexplained bleeding should undergo prompt histopathological evaluation to ensure early detection.Early diagnosis at a stage confined to the uterus allows curative treatment and significantly improves outcomes. A structured diagnostic algorithm incorporating clinical evaluation, imaging, and mandatory endometrial sampling is essential to avoid delayed recognition and progression to advanced disease.