OB-GYN Mistakes Cancer for Uterine Fibroids

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.

Question(s) For Expert Witness

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

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

3. Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.

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

Expert Witness Response E-023524

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. 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. Because Leiomyosarcomas tend in 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.