{
  "abstract": "Objective This study aimed to retrospectively characterise the clinical features of unexpected malignant endometrial lesions identified incidentally in patients undergoing hysterectomy for pelvic organ prolapse (POP) repair, and to identify potential high-risk factors to guide preoperative screening decisions in this population.Methods This study retrospectively reviewed patients who underwent hysterectomy for POP repair at Peking University People’s Hospital, a tertiary medical centre, between January 2008 and February 2024. A consecutive case series of women with unexpected postoperative malignant endometrial pathology was recruited. Demographic characteristics and auxiliary examination results were analysed to summarise the clinical features of these cases.Results Among 3588 asymptomatic women with negative preoperative auxiliary examinations who underwent concurrent hysterectomy for POP repair, 11 cases (0.3%) of unexpected malignant postoperative endometrial pathology were identified. Of these, 10 were endometrioid carcinoma, and one was uterine serous carcinoma; secondary staging surgery was performed in seven patients. Key clinical features among these 11 cases included advanced age (72.7%), overweight or obesity (60%) and hypertension (63.6%). Other comorbidities included hyperlipidaemia (27.3%), cardiovascular disease (18.2%), cerebrovascular disease (18.2%), diabetes (18.2%) and fatty liver (18.2%). Late-onset menopause or abnormal menstrual cycle history were seen in 9.1%. Tumour markers (CA125, CEA), though not routinely tested, were elevated in some patients. Notably, among cases with only overweight or obesity, 60% of occult cancers were identified. This detection rate increased to 90.9% with the addition of one metabolic syndrome complication and reached 100% in those with overweight and two or more metabolic syndrome components.Conclusion Unexpected endometrial malignancy was identified in 0.31% of asymptomatic women undergoing hysterectomy for POP repair despite negative preoperative screening. Overweight or obesity combined with metabolic syndrome components may represent a clinically relevant high-risk profile warranting consideration of targeted preoperative endometrial evaluation in women planning uterine-preserving pelvic floor repair, though prospective validation is needed before formal recommendations can be established.",
  "authors": [
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Wenyan Li"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Bing Xie"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Xiuli Sun"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Xin Yang"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Wang Jianliu"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Xiaowei Li"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Shiyan Wang"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Fang An"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China",
        "Beijing Key Laboratory for AI-Enabled Pelvic Floor Repair and Translational Medical Technologies, Beijing, China",
        "Research Center of Female Pelvic Floor Disorders of Peking University, Beijing, China"
      ],
      "name": "Xiaojie Yu"
    }
  ],
  "title": "Clinical characteristics for unexpected endometrial cancer following hysterectomy for pelvic organ prolapse repair",
  "uid": "696bb002-9222-568f-955d-040f9211321e"
}