Advanced Endometrial Cancer Mimicking Pelvic Inflammatory Disease in a Postmenopausal Woman—A Case Report

Background: Endometrial cancer is the most common gynecological malignancy in high-income countries, with recurrence occurring in approximately 8.3% of endometrioid endometrial carcinoma cases. Recurrence in elderly patients is associated with significantly worse outcomes, compounded by comorbidity burden, atypical clinical presentations, and the technical demands of salvage surgery. The co-occurrence of recurrent endometrioid endometrial carcinoma and acute salpingitis in an elderly patient represents a clinically complex and poorly characterized entity, with no systematic documentation in the current literature. Case Presentation: We report the case of a 78-year-old female patient who underwent open supracervical hysterectomy with bilateral adnexectomy for a large pelvic mass. Histopathological analysis confirmed locally advanced infiltrative endometrioid endometrial carcinoma, FIGO stage IIIA (pT3aNxMx), with concurrent acute purulent salpingitis and parasalpingeal abscesses of the left adnexa. An aggressive tumor progression of residual disease was identified at five months postoperatively, with CT imaging revealing a persistent uterine mass in direct contact with the bladder and a congenitally duplicated left ureter. Following multidisciplinary preoperative planning and Double-J catheter insertion, salvage completion surgery was successfully performed, including radical excision of the cervical stump and concurrent surgical reconstruction of the involved duplicated left ureters via direct bladder reimplantation and end-to-end anastomosis. The second histopathological examination confirmed recurrent locally advanced endometrioid endometrial carcinoma. Conclusions: Incomplete index resection with involved margins in advanced-stage (FIGO IIIA) high-risk endometrioid endometrial carcinoma can permit persistent residual tumor to progress aggressively. Salvage completion surgery in elderly patients with concurrent comorbidities and anatomical variants is highly complex and should be centralized in specialized units with integrated oncological, urological, and perioperative expertise.