Open Access

Endometrial cancer presenting as a snowball in the pelvis

  • Rakesh Sinha1,
  • Meenakshi Sundaram1, 2Email author,
  • Smita Lakhotia1 and
  • Pratima Kadam1
Gynecological SurgeryEndoscopic Imaging and Allied Techniques20108:599

Received: 3 May 2010

Accepted: 26 May 2010

Published: 11 June 2010


Endometrial carcinoma

Explanation image

Endometrial cancer is the commonest gynaecologic malignancy in the west and the third commonest after cervical and ovarian cancer in India [1]. The standard treatment for endometrial cancer has been primary surgery. Locally advanced disease, comprising lymph node metastases, adjacent organ invasion, positive peritoneal cytology or serosal invasion is uncommon and accounts for only 7% of cases [2]. To categorise a patient as having serosal invasion, it is mandatory to have full-thickness myometrial invasion with macroscopic tumour on the uterine surface. We present a patient with serosal disease with spontaneous perforation of the uterine wall by tumour, which presented in a unique manner at laparoscopy.

A 66-year-old lady presented with post-menopausal vaginal bleeding on and off for 9 months. Imaging with transvaginal ultrasound and MRI revealed a uterine mass with endometrial thickness of 12 mm. Under anaesthesia, a D&C with frozen-section analysis revealed a grade II endometroid adenocarcinoma. At laparoscopy, a bulky uterus with tumour plaque on the uterine surface which had formed a dense white sheet was seen (Figs. 1 and 2). The right ovary was also enlarged. Standard surgical staging and pan hysterectomy was done. The permanent sections revealed a FIGO grade II endometroid adenocarcinoma with uterine serosal invasion and an ovarian deposit as well. There were no metastases in the pelvic nodes or outside the pelvis. The disease was staged as IIIA grade II. She made an uneventful recovery and is currently receiving chemo-radiation. Review of literature did not reveal report of any similar case presenting like a snowball.
Fig. 1

Snowball in the pelvis

Fig. 2

Uterus covered by dense uniform whitish plaque


Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Authors’ Affiliations

Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery (BEAMS Hospital), Mumbai, India
, Mumbai, India


  1. Devi KU (2009) Current status of gynecological cancer care in India. J Gynecol Oncol 20(2):77–80View ArticleGoogle Scholar
  2. Ashman JB, Connell PP, Yamada D, Rotmensch J, Waggoner SE, Mundt AJ (2001) Outcome of endometrial carcinoma patients with involvement of the uterine serosa. Gynecol Oncol 82(2):338–343PubMedView ArticleGoogle Scholar


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