Date Posted: June 10, 2026

Author/s: Beatriz Carmela R. Glorioso, RN, MD and Lylah D. Reyes, MD, MSc, FPOGS

Abnormal uterine bleeding after a spontaneous abortion requires a thorough diagnostic work-up to be able to identify the appropriate management. Imaging modalities such as Transvaginal ultrasound with Doppler studies together with physical and laboratory findings are beneficial to narrow the differential diagnoses. There are a number of conditions that may present as endometrial mass with myometrial invasion and increased uterine vascularity including retained products of conception, gestational trophoblastic disease, uterine arteriovenous malformation, placenta accrete syndrome, and a possible endometrial neoplasm. This is a case of a 29-year-old, Gravida 1 Para 0 (0010), with an unexplained postabortal bleeding despite curettage which poses a diagnostic challenge. A consideration of retained products of conception versus a gestational trophoblastic neoplasia on ultrasound were made. She underwent diagnostic hysteroscopy followed by suction curettage and biopsy. The histopathologic result revealed poorly differentiated neoplasm with the considerations of endometrial adenocarcinoma endometrioid pattern and carcinosarcoma (malignant mixed mullerian tumor). Endometrial cancer is rarely associated with pregnancy and less than 5% of cases occurs in women aged less than 40 years old.6 The concurrence of pregnancy and endometrial cancer is sporadic. It is usually diagnosed in the first trimester after dilatation and curettage for spontaneous abortion. The primary treatment modality for endometrial cancer is surgery. Aside from staging, surgery will help identify the correct histologic diagnosis. If diagnosis is still uncertain, additional modalities such as immunohistochemical staining may be necessary. Confirming the diagnosis and stage will aid in identifying the need for adjuvant treatment such as chemotherapy.

Keywords:
vaginal bleeding, retained products of conception, endometrial adenocarcinoma, carcinosarcoma