Endometrial carcinoma (HSG)

Endometrial Carcinoma – Hysterosalpingography

Endometrial carcinoma is a malignant neoplasm arising from the endometrial lining of the uterus and is the most common gynecologic malignancy. It typically presents in peri- or postmenopausal women with abnormal uterine bleeding. Although hysterosalpingography (HSG) is not routinely performed for diagnosis, characteristic abnormal cavity findings may be encountered incidentally. On HSG, endometrial carcinoma is suggested by irregular, ill-defined filling defects, cavity destruction, and rigidity of the uterine walls (Fig. 1).

Fig-1

Fig. 1—Hysterosalpingogram suggestive of endometrial carcinoma. The uterine cavity shows irregular, ragged margins with an ill-defined filling defect and partial obliteration of the cavity (arrows).

Findings: The uterine cavity is distorted with irregular outlines and non-uniform contrast coating. Large, poorly marginated filling defects are seen, sometimes associated with reduced cavity distensibility. Tubal opacification may be absent or incomplete.

Conclusion: Hysterosalpingographic findings are suspicious for endometrial carcinoma. Histopathological correlation is mandatory.

Patient Symptoms

Patients commonly present with postmenopausal bleeding, menorrhagia, intermenstrual bleeding, pelvic pain, or abnormal vaginal discharge. Advanced disease may present with weight loss or anemia.

Procedure (Hysterosalpingography)

HSG is rarely indicated when malignancy is suspected. If performed incidentally, it is done during the early proliferative phase of the menstrual cycle using minimal contrast under fluoroscopic guidance.

Contrast Medium & Administration

A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position. Only a small volume (4–6 mL) of contrast is injected gently to outline the cavity.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Uterine tenaculum (if required)
• Leech–Wilkinson cannula
• Rubin cannula
• Balloon HSG catheter
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

HSG should be avoided when endometrial carcinoma is clinically suspected due to the risk of tumor dissemination. Endometrial biopsy or hysteroscopy is preferred for diagnosis.

Related Conditions

Differential diagnoses include endometrial hyperplasia, large endometrial polyp, submucosal fibroid, and chronic endometritis. Transvaginal ultrasound, MRI, and histopathological examination are essential for definitive diagnosis and staging.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved and no identifiable information is disclosed.