This article reports a 33-year-old woman with neuroendocrine carcinoma of the endometrium (NECE) with a chief complaint of profuse vaginal bleeding. The patient received emergency radiotherapy to control the bleeding and was discharged. She did not return for four months to undergo a scheduled surgery because she had been hospitalized in another hospital with a COVID-19 infection. She eventually returned due to shortness of breath caused by lung metastasis identified from a chest X-ray. She underwent a total hysterectomy, bilateral salpingo-oophorectomy, and concurrent pelvic and paraaortic lymphadenectomy. The final pathology revealed stage IVB high-grade NECE. The patient died four weeks after surgery from the worsening lung metastases. The aggressive spread, challenging diagnostic nature, and rarity of NECE contribute to the high prevalence of metastasis at the time of diagnosis and poor prognosis. A prospective clinical trial must be performed to formulate an urgently needed guideline for treating NECE. © 2024, African Field Epidemiology Network. All rights reserved.