A RARE DIAGNOSIS OF EIN FOLLOWİNG UTERINE-PRESERVING SURGERY FOR PELVIC ORGAN PROLAPSE: A CASE REPORT

Beydemir E., Geçer F. D., Söyleyici B., Karabacak R. O.

ESGE 34th Annual Congress / 19th – 22nd October 2025 – Istanbul, Turkey, İstanbul, Türkiye, 19 - 22 Ekim 2025, ss.1, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: İstanbul
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.1
  • Gazi Üniversitesi Adresli: Evet

Özet

Background

Pelvic organ prolapse (POP) significantly affects the quality of life in multiparous women, often requiring surgical management. While uterine-preserving procedures like theManchester-Fothergill technique are favored in selected patients, retained uterus poses long-term risks for endometrial pathology. Endometrial intraepithelial neoplasia (EIN) is a premalignant lesion that may coexist with endometrial adenocarcinoma and can remainasymptomatic. Preoperative evaluation is critical in patients presenting with abnormaluterine bleeding (AUB), even when imaging findings are benign.

 

Methods

We present a case of a 45-year-old multiparous woman with Stage III POP and a history of dysfunctional uterine bleeding previously treated with DMPA. The patient underwentcombined anterior and posterior colporrhaphy and a Manchester-Fothergill procedure. Dueto her history of postmenopausal bleeding, intraoperative endometrial sampling wasperformed. Histopathology revealed EIN, leading to a second-stage total laparoscopichysterectomy with bilateral salpingo-oophorectomy (TLH + BSO).

 

Results

The initial surgery was completed uneventfully, and POP symptoms improved significantly. EIN was diagnosed based on gland-stroma ratio and atypical glandular proliferation. Thepatient opted for reoperation. TLH + BSO was performed laparoscopically withoutcomplications. Final pathology showed chronic cervicitis, inactive endometrium, adenomyosis, benign follicular cysts, and Morgagni cysts in the fallopian tubes, with noevidence of EIN or malignancy. Postoperative follow-up at 6 weeks and 3 months showedcomplete resolution with no recurrence.

 

Conclusions

This case illustrates the potential for occult endometrial pathology following uterine-preserving POP surgery. Routine endometrial evaluation, even in cases with thinendometrium and no alarming ultrasound findings, is essential when risk factors such as AUB, multiparity, or DMPA history are present. Early detection via intraoperative biopsyenabled curative treatment and highlights the value of a vigilant diagnostic approach