Sudden death of a middle aged woman with a series of undiagnosed gynaecologic diseases

•A fatal case in a middle aged woman with gynaecologic diseases is presented.•Autopsy revealed the endometrial cancer, endometriosis and polycystic ovary syndrome.•The hypoplasia of coronary artery and micro pituitary adenoma were also observed.•It was considered that all the diseases collaborated to induce acute cardiac failure.•Gynaecologic diseases may be significant in a fatal cause of reproductive-aged women.

Gynaecologic diseases unrelated to pregnancy are not generally associated with sudden death, which limits the number of case reports published in the field of forensic medicine. Presented in this paper is a fatal case in a middle aged woman with an early stage endometrial cancer and a series of gynaecologic diseases, in whom such typical features of sudden death were not applicable. Forensic autopsy revealed the hypoplasia of left circumflex coronary artery, Stage 1B endometrial cancer, endometriosis, polycystic ovary syndrome (PCOS) and micro pituitary adenoma, whereas histochemical analyses confirmed hyperprolactinemia and hyperestradiolemia. It was considered that the hypoplasia of coronary artery, chronic anaemia and electrolyte imbalance due to endometrial cancer all collaborated to induce acute cardiac failure. The association between prolactinoma, PCOS and endometrial cancer was also suggested, though they are rarely observed synchronously.It was speculated that the deceased had been anaemic for a substantial period of time and lacked clear subjective symptoms, which made the antemortem diagnosis of her underlying diseases difficult. Forensic pathologists must always consider the possibility of gynaecologic diseases taking significant part in a fatal cause of reproductive-aged women.