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A 65-year-old menopausal woman consulted regarding 3-week duration of vaginal spotting, for which transvaginal ultrasound (TVS) was done and showed an 8.2-mm thickened endometrium with dilated cavity and suspicious endocervical lesion [Figure 1]. The following day, hysteroscopy was performed which revealed a proliferative phase endometrium and papillary outgrowth at the endocervical canal, for which a biopsy was obtained [Figure 2]. Histopathological report showed atypical complex hyperplasia, suggestive of endometrioid carcinoma. Two weeks later, she underwent laparoscopic staging surgery (total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, Para-aortic lymph nodes dissection, peritoneal cytology). Final pathology account was well-differentiated endometrioid adenocarcinoma in atypical complex hyperplasia, T1aN1 and metastatic adenocarcinoma on the right pelvic nodes.

Hysteroscopy as a tool for identification of uterine endocervical lesion