The patient had presented 3 months earlier with postmenopausal bleeding. Her staging scan showed a diffusely infiltrative endometrial tumor extending to the serosa at the left lateral fundus and invading the cervical stroma. Initial tumor staging was FIGO stage II. The patient was due to start palliative chemo-radiotherapy.

In the post-menopausal patient, hematometra develops in the setting of cervical stenosis usually caused by either normal aging, post-radiotherapy fibrosis or tumor involvement of the endometrium or cervix ¹.  In this case, the friable endometrial tumor had infiltrated the uterine cervix. 

Hematosalpinx can be seen in untreated cervical stenosis where tumor debris and blood reflux from the uterus and distend the fallopian tube ². In this case of advanced endometrial carcinoma, hematosalpinx developed due to tumor infiltration of the serosal layer of the left lateral fundus with involvement of the isthmus of the left fallopian tube.