Endometrial ossification, also described as endometrial osseous metaplasia (EOM), is a rare benign condition characterized by the presence of bone tissue within the endometrium. Its exact etiopathogenesis remains unclear, although the metaplasia of endometrial stromal cells into osteoblast-like cells has been proposed as the most accepted mechanism. Clinically, it may present with infertility, abnormal uterine bleeding, or pelvic discomfort and, in rare situations, may mimic more serious gynecological pathology. We report the case of a 60-year-old postmenopausal woman who presented with persistent vaginal bleeding, vaginal discharge, and a protruding vaginal mass causing discomfort. She had a long history of recurrent postmenopausal bleeding (PMB) and previously diagnosed benign endometrial polyps managed with hysteroscopic polypectomy. Imaging revealed a markedly thickened, inhomogeneous endometrium with multiple polypoidal lesions and calcifications, raising suspicion for endometrial malignancy with possible cervical involvement. Due to persistent symptoms, suspicious imaging findings, and the patient's multiple comorbidities, a robotic total hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathological examination unexpectedly revealed the ossifying cartilaginous metaplasia of the endometrial stroma involving the endometrium and an endometrial polyp, with no evidence of malignancy. The patient had an uneventful recovery and remained asymptomatic on follow-up. This case highlights how a rare benign diagnosis can present in a complex clinical scenario mimicking malignancy. The awareness of such entities is important to avoid misdiagnosis and to emphasize the crucial role of histopathology and multidisciplinary management in achieving safe, patient-centered care.

The most common sites of breast cancer metastasis include the bone, lung, liver, and brain. Metastasis to the uterine cervix and endometrium is uncommon and can mimic primary gynecologic malignancies, leading to substantial diagnostic challenges. The authors have reported a 56-year-old postmenopausal woman with metastatic invasive mammary carcinoma of the left breast, including biopsy-confirmed liver metastasis, who presented after a syncopal event following an episode of heavy vaginal bleeding. Following her presentation, she underwent cervical and endometrial biopsies. Cervical biopsy revealed scattered discohesive tumor cells positive for GATA3, mammoglobin, TRPS1, AE1/3, and CAM5.2 and negative for PAX8, which were consistent with metastatic breast carcinoma. Endometrial biopsy showed cohesive nests of atypical carcinoma with diffuse p16, p63, and CK5/6 positivity and negative staining for mammoglobin, TRPS1, SOX10, and PAX8, initially raising concern for a human papillomavirus-associated squamous cell carcinoma. Following multidisciplinary evaluation, it was established that these features represented metastatic breast human papillomavirus-associated squamous cell carcinoma to the endometrium rather than a new primary gynecologic malignancy. This case highlighted the importance of considering metastatic disease in patients with breast cancer presenting with abnormal uterine bleeding and demonstrated the value of multidisciplinary evaluation in determining an accurate diagnosis.

Foreign bodies in the female genital tract are rare, especially in postmenopausal women. Common foreign bodies reported in the elderly include forgotten pessaries and intrauterine contraceptive devices. A 60-year-old woman, para 5 live 5 (P5L5), presented with complaints of postmenopausal bleeding (PMB). On per speculum examination, the vagina was pale and atrophic, and the cervix appeared healthy. Bimanual examination revealed an atrophic uterus with no adnexal mass. Transvaginal sonography showed an endometrial thickness of 8 mm. On hysteroscopy, a golden-colored material measuring 1 cm × 0.5 cm was visible, attached to the endometrial cavity. No other pathology was detected except for an atrophic endometrium. The foreign body was removed using hysteroscopic forceps. It was identified as paddy husk (rice husk). This case highlights an unusual presentation of PMB caused by paddy husk, identified unexpectedly during hysteroscopy.

Hysteroscopy is central to evaluating suspected intrauterine pathology, yet the histopathological yield of referral indications and the predictive value of ultrasound and hysteroscopic impressions in tertiary practice remain insufficiently defined. We retrospectively reviewed consecutive women aged ≥18 years who underwent diagnostic or operative hysteroscopy at a tertiary referral center in Ankara, Türkiye, between January and December 2025. Referral indication, transvaginal ultrasound impression, hysteroscopic impression, and final histopathology were recorded. Category-specific positive predictive values (PPVs) were calculated with Wilson 95% confidence intervals (CIs). The sonographic impression was additionally dichotomized against histopathology at both a strict and a broad threshold, and sensitivity, specificity, and likelihood ratios were derived. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Among 1551 procedures, 1250 women were pre/perimenopausal, and 301 were postmenopausal. Final histopathology was available in 1455 cases (93.8%). The most common diagnoses were endometrial polyp (957; 65.8%), benign endometrium (477; 32.8%), and endometrial carcinoma (21; 1.4%). Indications differed by menopausal status (P < .001): abnormal uterine bleeding predominated before menopause (908; 72.6%), whereas postmenopausal bleeding predominated after menopause (144; 47.8%). Indication-stratified yield also differed significantly (P < .001). Endometrial carcinoma was rare before menopause and clustered in postmenopausal women with bleeding. Among postmenopausal women, carcinoma was found in 11.1% (16/144) of those referred with bleeding but in only 1.3% (2/157) of those referred for other reasons; among pre/perimenopausal women, the corresponding figures were 0.3% (3/884) and 0% (0/270). Bleeding, therefore, raised carcinoma yield only after menopause. Ultrasound suggesting an endometrial polyp was confirmed in 86.4% (603/698; 95% CI: 83.6-88.7), while ultrasound suspicious for malignancy predicted carcinoma in 85.7% (18/21; 95% CI: 65.4-95.0). A hysteroscopic impression of an endometrial polyp showed a PPV of 90.2% (202/224; 95% CI: 85.6-93.4). For polyp detection, a definite sonographic impression was specific but insensitive (specificity 80.9%, sensitivity 63.0%); admitting suspected polyps raised sensitivity to 95.0%, while specificity fell to 50.2% (negative likelihood ratio, 0.10). Definite focal or malignancy-suspicious ultrasound and hysteroscopic impressions carried a high PPV. Carcinoma risk was governed by the combination of menopausal status and bleeding rather than by bleeding alone, which supports triage based on both factors jointly. Histopathological confirmation remains indispensable.

High-grade appendiceal mucinous neoplasm is an extremely rare gastrointestinal tumour with nonspecific clinical manifestations that complicate preoperative diagnosis. In women, it may mimic gynecological diseases, particularly ovarian tumours, leading to diagnostic delays and inappropriate surgical approaches. We report the case of a 68-year-old woman from the San Martín region of Peru who presented with abdominal pain, progressive distension, and abnormal vaginal bleeding. Laboratory tests showed elevated carcinoembryonic antigen levels, while transvaginal ultrasound revealed a right adnexal mass suggestive of ovarian neoplasia. During surgery, a mucinous appendiceal mass without ovarian involvement was incidentally identified, prompting modification of the surgical plan to an oncological right hemicolectomy. Histopathological analysis confirmed high-grade mucinous adenocarcinoma of the appendix. The postoperative course was favorable. This case highlights the importance of considering appendiceal neoplasms in the differential diagnosis of pelvic masses in postmenopausal women and the value of intraoperative and histopathological evaluation.

The case of a 58-year-old immunocompetent woman with no relevant medical history, presenting with pelvic pain and postmenopausal bleeding, is reported. Imaging studies revealed findings compatible with disseminated endometrial cancer, including pulmonary lesions suspicious for metastasis, for which advanced gynecological cancer was initially presumed; however, endometrial biopsy showed necrotizing granulomas with acid-fast bacilli, confirming endometrial tuberculosis (TB). Likewise, pulmonary TB involvement was evidenced (positive sputum smear), establishing the final diagnosis of disseminated TBsimulating a gynecological cancer. The patient received standard anti-TB treatment for six months, with complete remission of symptoms. A post-treatment follow-up biopsy was negative for TB. This case emphasizes the importance of considering genital TB in the differential diagnosis of gynecological neoplasms, even in immunocompetent postmenopausal patients, especially in TB-endemic regions, to ensure timely diagnosis and management.

Female genital tuberculosis should be considered in the differential diagnosis of postmenopausal women presenting with abnormal vaginal bleeding, even in the absence of pulmonary tuberculosis history. For confirmed vulvar and cervical lesions, biopsy with acid-fast staining and culture enables prompt diagnosis and cure, while suspected endometrial involvement requires histopathological and microbiological confirmation.

Endometrial cancer is the most common gynecological malignancy in high-income countries. Although postmenopausal bleeding is its cardinal presenting symptom, only 5-10% of women with postmenopausal bleeding have malignancy. There is therefore a need for accurate, minimally invasive diagnostic tests. Proteins detectable in proximal biofluids, particularly cervicovaginal fluid (CVF), represent promising biomarkers because they reflect the functional biology of the tumor and can be measured using clinically translatable immunoassays.

Mesonephric-like adenocarcinoma (MLA) is a recently recognized and rare entity. It is a morphologically distinctive carcinoma of the uterine corpus, estimated to account for approximately 1% of endometrial malignancies. Its diagnosis is particularly challenging owing to morphological and immunophenotypic overlap with cervical mesonephric adenocarcinoma and other endometrial carcinoma subtypes. Accurate identification has significant clinical implications given its association with aggressive behavior. We report the case of a 62-year-old postmenopausal woman who presented with a two-day history of postmenopausal vaginal bleeding. A PET/MR fusion scan revealed a metabolically active, T2-hyperintense lesion involving the posterior uterine wall and lower uterine segment, associated with haematometra. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and comprehensive surgical staging. Histopathological examination demonstrated a high-grade carcinoma with tumor cells arranged in small tubules, nests, and sheets, containing intraluminal eosinophilic secretions, a pattern characteristic of mesonephric-like differentiation. Immunohistochemistry showed diffuse positivity for GATA3 and PAX8, with wild-type p53 expression, supporting the diagnosis of MLA. Tumor invasion exceeded 50% of the myometrial thickness (93.75%), with negative lymph nodes and clear surgical margins, yielding a final stage of pT1b pN0 (the International Federation of Gynecology and Obstetrics (FIGO) stage IIC). This report underscores the critical importance of integrating classical morphological assessment with a targeted immunohistochemical panel in diagnosing MLA. As this entity is increasingly recognized, pathologists must maintain a high index of suspicion, particularly in postmenopausal women with tumors exhibiting tubular architecture and eosinophilic luminal secretions.