title: Cervical endometriosis associated with malignant pleural mesothelioma mimicking cervical cancer--Occam's razor or the "third man".
abstract: OBJECTIVE
  To illustrate pitfalls in the diagnosis of endometriosis and cervical cancer.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital, department of obstetrics and gynecology.
  
  
  METHODS
  A 45-year-old woman with menorrhagia, pelvic mass, right-sided hydronephrosis, and unexplained weight loss.
  
  
  METHODS
  Cervical biopsies were suggestive of cervical endometriosis. Laparoscopy confirmed endometriosis. Associated pleural effusion, without cytologic signs of malignancy, was interpreted as caused by thoracic endometriosis. The patient had a transabdominal hysterectomy and unilateral salpingo-oophorectomy. Histopathologic examination confirmed endometriosis and revealed a residual tubo-ovarian abscess. After surgery, the patient developed spontaneous seropneumothorax. Pleural biopsies revealed a well-differentiated epithelial malignant pleural mesothelioma. The patient underwent hypofractionated radiation of drain sites. She is now observed in our outpatient clinic.
  
  
  METHODS
  Steps to the correct diagnosis.
  
  
  RESULTS
  The patient had an association of cervical and pelvic endometriosis, residual tubo-ovarian abscess, and malignant pleural mesothelioma.
  
  
  CONCLUSIONS
  Usually, the simplest diagnosis explaining a complex of symptoms and clinical and diagnostic findings is the one most likely to be correct. This is an application of Occam's razor to medicine. Our case illustrates that occasionally the simplest and therefore most probable diagnosis can be wrong, and on these occasions one should consider a "third man."
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of Würzburg, Würzburg, Germany. joergbengel@hotmail.com
authors.forename: Jörg B
authors.initials: JB
authors.lastname: Engel
authors.forename: Stefan
authors.initials: S
authors.lastname: Heuer
authors.forename: Sabine
authors.initials: S
authors.lastname: Segerer
authors.forename: Stephan
authors.initials: S
authors.lastname: Rauthe
authors.forename: Johannes
authors.initials: J
authors.lastname: Dietl
authors.forename: Arnd
authors.initials: A
authors.lastname: Hönig
mesh_terms: D003937:Diagnosis, Differential; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D010819:Physician's Role; D010997:Pleural Neoplasms / Q000150:complications / Q000175:diagnosis*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D002577:Uterine Cervical Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*