OB-GYN Mistakes Cancer for Uterine Fibroids

Case Overview

This case takes place in Massachusetts and involves a woman who died as a result of undiagnosed uterine cancer. The woman presented to the hospital complaining of a pelvic mass. A pelvic ultrasound reported multiple fibroids. The patient discussed the ultrasound with her OB-GYN, who recommended a total hysterectomy. The patient appealed to her primary care physician for a second opinion and was referred to another OB-GYN. On The second OB-GYN, upon reviewing a report of the patient’s cervical examination, advised that the mass was benign and non-cancerous, therefore hysterectomy or any other kind of tumor cryoablation was not necessary. No further tests were ordered. The patient did not follow up on her diagnosis for several years until she presented to the hospital with complaints of pelvic pain, at which point her cancer was discovered. Her condition continued to worsen over several months until she died.

Questions to the Gynecology expert and their responses

Do you routinely treat patients similar to the one described in the case? Please explain.

My expertise is urogynecology and managing disorders of the female pelvic floor. In the course of caring for these patients, I commonly see and manage women in this age group with uterine fibroids.

Have you ever had a patient develop the outcome described in the case? If so, please explain.

Because Leiomyosarcomas tend to occur in the perimenopausal and postmenopausal group, my partners and I occasionally see patients with fibroids who go on to have leiomyosarcomas. I personally have not had a patient with fibroids whom we followed conservatively and eventually develop leiomyosarcoma.

Please briefly tell us why you?re qualified to serve as an expert reviewer of this case.

It is not unreasonable to follow fibroids conservatively as most are benign. However, it appears that she was symptomatic for several years and there is evidence of growth of the mass. In the summary provided, I am concerned about the followup on these symptomatic fibroids in this perimenopausal woman. In addition, I would like to see the documentation concerning the risk of fibroids in this patient.

About the expert

This highly qualified expert is board certified in obstetrics and gynecology and has been practicing for 16+ years. He received his MD and MHS degrees from Duke University and his MMM degree from the University of Rochester. He completed his residency training focusing on gynecologic oncology at Sloan Kettering Memorial Hospital, Beth Israel Deaconess Medical Center and Harvard University before concluding his fellowship training at Duke University. He is a member of various professional associations, including the American Urogynecologic Society and the American College of Obstetrics and Gynecology. He has published 29+ peer-reviewed journal articles and delivers lectures nationwide. Currently, he is the chief of the Female Pelvic Medicine and Reconstructive Surgery Division at a major university, where he is also an associate professor of OB/GYN and urology and the director of the female pelvic medicine and reconstructive surgery fellowship program.