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Purpose <p>Infertility is recognized as a risk factor for premalignant and malignant endometrial lesions, as well as ovarian cancer. However, there is limited literature on the overall incidence and nature of unexpected endometrial premalignant or malignant lesions and ovarian cancer in women undergoing infertility workup.</p> Methods <p>This was a retrospective, descriptive study conducted from November 1, 2021, to February 29, 2024, at Grande City Hospital, Kathmandu, Nepal. The study included women who primarily presented or were referred for hystero-laparoscopic evaluation of subfertility without any clinical or radiological suspicion of malignancy. Endometrial or adnexal biopsies were taken whenever indicated.</p> Results <p>During the study period, a total of 1,276 cases underwent hysteroscopy, 443 underwent hystero-laparoscopy, and 53 underwent laparoscopy alone for infertility evaluation. In total, 1,719 hysteroscopies and 496 laparoscopies were performed. Endometrial biopsy was obtained in 42% of hysteroscopy cases (721 cases). Laparoscopic salpingectomy was performed in 295 cases, cystectomy in 112 cases, and both procedures in 84 cases. Endometrial intraepithelial neoplasia (EIN) was detected in 7 cases, and endometrial cancer (EC) in 3 cases. One ovarian malignancy (granulosa cell tumor) was reported. The combined prevalence of atypical hyperplasia and cancer was 0.6% (6 per 1,000) hysteroscopy cases or 1.3% (13 per 1,000) endometrial biopsies. For EIN alone, prevalence was 0.4% of hysteroscopies or 0.9% of biopsies, while for endometrial cancer, it was 0.17% of hysteroscopies or 0.4% of biopsies. Only one case of granulosa cell tumor was identified among all laparoscopies, giving a prevalence of 0.2%.</p> Conclusion <p>Endometrial pathology (premalignant or malignant) was more common than adnexal pathology in infertile women. Clinicians should remain vigilant for unexpected malignancies during infertility evaluation. Early diagnosis enables fertility-preserving management with favorable prognosis.</p>

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Unexpected Premalignant And Malignant Lesion Of Endometrium And Ovary In Fertility Workup

  • 期刊论文

  • 发表日期：

    2025年12月27日

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  • S. Kayastha

摘要

Purpose

Infertility is recognized as a risk factor for premalignant and malignant endometrial lesions, as well as ovarian cancer. However, there is limited literature on the overall incidence and nature of unexpected endometrial premalignant or malignant lesions and ovarian cancer in women undergoing infertility workup.

Methods

This was a retrospective, descriptive study conducted from November 1, 2021, to February 29, 2024, at Grande City Hospital, Kathmandu, Nepal. The study included women who primarily presented or were referred for hystero-laparoscopic evaluation of subfertility without any clinical or radiological suspicion of malignancy. Endometrial or adnexal biopsies were taken whenever indicated.

Results

During the study period, a total of 1,276 cases underwent hysteroscopy, 443 underwent hystero-laparoscopy, and 53 underwent laparoscopy alone for infertility evaluation. In total, 1,719 hysteroscopies and 496 laparoscopies were performed. Endometrial biopsy was obtained in 42% of hysteroscopy cases (721 cases). Laparoscopic salpingectomy was performed in 295 cases, cystectomy in 112 cases, and both procedures in 84 cases. Endometrial intraepithelial neoplasia (EIN) was detected in 7 cases, and endometrial cancer (EC) in 3 cases. One ovarian malignancy (granulosa cell tumor) was reported. The combined prevalence of atypical hyperplasia and cancer was 0.6% (6 per 1,000) hysteroscopy cases or 1.3% (13 per 1,000) endometrial biopsies. For EIN alone, prevalence was 0.4% of hysteroscopies or 0.9% of biopsies, while for endometrial cancer, it was 0.17% of hysteroscopies or 0.4% of biopsies. Only one case of granulosa cell tumor was identified among all laparoscopies, giving a prevalence of 0.2%.

Conclusion

Endometrial pathology (premalignant or malignant) was more common than adnexal pathology in infertile women. Clinicians should remain vigilant for unexpected malignancies during infertility evaluation. Early diagnosis enables fertility-preserving management with favorable prognosis.