A 47 year old morbidly obesity nulligravid female presented to a local hospital with chest pain and shortness of breath, CT of the chest confirmed pulmonary embolism, and endometrial biopsy performed showed grade 1 endometrioid adenocarcinoma with squamous differentiation. CT scan performed demonstrated pelvic, retroperitoneal, inguinal and right axillary lymphadenopathy, and hepatomegaly with grossly unremarkable uterus and ovaries. Due to the burden of disease, axillary and inguinal lymph node biopsy was attempted, however due to depth of nodes, the tissue was not reached and biopsy efforts were abandoned. It required a great deal of discussion with the radiology department to decide which lesion would be least morbid to biopsy. After failed attempts at several methods, the gastroenterologist consulted felt the retroperitoneal lymphadenopathy adjacent to the duodenum was a possibility. The sample was sparse, but confirmed a metastatic adenocarcinoma and ruled out an inflammatory or granulomatous process. Ultimately, this unfortunate woman’s obesity caused her to have a worse outcome, not only due to medical comorbidities, but also with regards to delayed diagnosis and treatment and progression of disease. As the obesity epidemic worsens, this is likely to occur more commonly. It is important to realize the limitations of our consults as all aspects and fields of medicine are limited by morbid obesity.
morbid obesity, endometrial cancer, diagnosis
Copyright © Janna Girardi, Michael J. Goodheart, 2011.
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