Diagnostic management of endometrial cancer in a single horn of a bicornuate uterus

As more than 65 000 women are diagnosed with endometrial cancer annually in the US, and uterine malformations are relatively common in the general population (reported in up to 5%, with 25% of these being bicornuate uteri), the diagnostic and therapeutic implications of uterine malformations in patients with endometrial cancer are an under-reported clinical issue.1, 2 To raise awareness of potential diagnostic and therapeutic pitfalls, we present a rare case of early stage endometrial cancer arising in a single horn of a bicornuate uterus (Figure 1). The patient was diagnosed by hysteroscopy and directed biopsies following postmenopausal bleeding and qualified for robotic hysterectomy with bilateral indocyanine green based sentinel lymph node resection, which was performed without complications. To date, evidence regarding the potential clinical implications of uterine malformations in relation to endometrial cancer is limited and largely confined to case reports.3 While anatomical variations may decrease diagnostic sensitivity and increase surgical complexity, there is no evidence suggesting impaired oncologic outcomes when uterine malformations are present. Therefore, if hysterectomy is deemed technically feasible without the risk of tumor spillage, there seems to be no contraindication for minimal invasive management in cases of early-stage disease.