title: Post-menopausal vaginal bleeding caused by carcinoma of the appendix: a case report.
abstract: BACKGROUND
  Post-menopausal blood loss is a common complaint of patients seen in gynecological practice. The most frequent malignancy found in cases of post-menopausal bleeding is endometrial cancer. Other causes can be malignancies of the rest of a woman's genital tract or metastases from other tumors. To the best of our knowledge, it appears that this is the first published case of a post-menopausal primary appendiceal carcinoma presenting with vaginal blood loss.
  
  
  METHODS
  A 75-year-old Caucasian woman with a history of vaginal hysterectomy presented with a 10-month history of post-menopausal blood loss. After extensive examination and discussion, ovarian carcinoma was suggested. Microscopic examination of the tissue removed at laparotomy revealed an adenocarcinoma of the appendix. She was treated with adjuvant radiotherapy and with palliative chemotherapy after 14 months because of intra-abdominal metastatic disease.
  
  
  CONCLUSIONS
  Post-menopausal blood loss in a patient with a history of hysterectomy is uncommon and always needs further investigation.
authors.affiliation: Department of Obstetrics and Gynecology, Groene Hart Ziekenhuis, PO Box 1098, 2800 BB Gouda, the Netherlands. hvhuisseling@gmail.com.
authors.forename: Hans
authors.initials: H
authors.lastname: van Huisseling
authors.forename: Lennie
authors.initials: L
authors.lastname: van Hanegem
authors.forename: Martin
authors.initials: M
authors.lastname: van Dijk