SYNCHRONOUS PRIMARY OVARIAN ENDOMETRIOID CARCINOMA AND POORLY DIFFERENTIATED ENDOMETRIAL STROMAL SARCOMA
Abstract
INTRODUCTION: The presence of two genital malignant tumors at the same time is a rare phenomenon with a incidence of 0.7%. They are mostly localized in the uterus and ovary, of which about 50% are identical endometrioid - endometrioid histological type. In the case of the presence of two different histological types of tumors, diagnosis is easier to be made, but because of the small number of displayed cases there are no precise data on their clinical course. Generally, women with synchronous endometrial and ovarian tumors have a better prognosis, and more frequently are younger, obese, multiparous and in menopause, in comparison with women who have metastatic ovarian cancer or endometrial cancer.
CASE REPORT: In this work we present a woman aged 53 years, who contacted gynecologist because of the irregular uterine hemorrhage. The gynecological exam revealed a tumor protruding through the cervical canal. The biopsy with initial histopathological diagnosis, and additional EHO and CT search, indicated the presence of a cervical tumor spreading over the uterus and both uterine adnexa. After surgical intervention, macroscopic and microscopic analysis of the postoperative material showed the simultaneous presence of two different malignancies: ovarian endometrioid carcinoma and poorly differentiated endometrial stromal sarcoma that infiltrated all layers of the uterus, cervix and both fallopian tubes.
CONCLUSION: Prognosis of the synchronous tumors of the ovary and the uterus is primarily dependent on the stage and histological type of each tumor. Because of the rather small number of reported cases, the large part this phenomenon remains unknown. Our report is the first description of the synchronous occurrence of the endometrial ovarian carcinoma and uterine stromal sarcoma.
References
Tong SY, Lee YS, Park JS, Bae SN, Lee JM, Namkoong SE. Clinical analysis of synchronous primary neoplasms of the female reproductive tract. Eur J Obstet Gynecol Reprod Biol 2008;136:78-82.
Gungor T, Kanat Pektas M, Ustunyurt E, Mollamahmutoglu L. Synchronous primary tumors of the female genital tract:a single center experience. Arch Gynecol Obstet, 2009;279:667–72
Staging classifications and clinical practice guidelines of gynaecological cancers by the FIGO Committee on Gynecologic Oncology.3rd ed. Oxford: Elsevier, 2000.
Eisner RF, Nieberg RK, Berek JS. Synchronous primary neoplasms of the female reproductive tract. Gynecol Oncol 1989;33:335-9.
AlHilli MM, Dowdy SC, Weaver AL et al. Incidence and factors associated with synchronous ovarian and endometrial cancer: A population-based case-control study. Gynecologic Oncology 2012;125:109-13.
Soliman PT, Slomovitz RR, Broaddus RR et al.Synchronous primary cancers of the endometrium and ovary: a single institution review of 84 cases. Gynecol Oncol, 2004; 94:456–462.
Huang YD, Hung YC, Yeh LS, Chiang IP, Zeng GC, Chang WC. Synchronous ovarian endometrioid adenocarcinoma and endocervical mucinous adenocarcinoma. Taiwan J Obstet Gynecol 2006;45:264-7.
Atasever M, Yilmaz B, Dilek G, Akcay EY, Kelekci S. Synchronous primary carcinoma in 5 diferent organs of a female genital tract: an unusual case and review of the literature. Int J Gynecol Cancer 2009;19:802–7.
Singh N. Synchronous tumours of the female genital tract. Histopathology 2010;56:277–85.
Williams MG, Bandera EV, Demissie K, Rodriguez-Rodriguez L. Synchronous primary ovarian and endometrial cancers: a population-based assessment of survival. Obstet Gynecol 2009;113:783–9.
van Niekerk CC, Bulten J, Vooijs GP, Verbeek AL. The association between primary endometrioid carcinoma of the ovary and synchronous malignancy of the endometrium. Obstet Gynecol Int, 2010; doi: 10.1155/2010/465162.
Pan Z, Wang X, Zhang X, Chen X, Xie X. Retrospective analysis on coexisting ovarian cancer in 976 patients with clinical stage I endometrial carcinoma. J Obstet Gynaecol Res, 2011;37:352–8.
Zaino R, Whitney C, Brady M, Degeest K, Burger R, Buller R. Simultaneously detected endometrial and ovarian carcinomas—a prospective clinicopathologic Study of 74 cases: a Gynecologic Oncology Group Study. Gynecol Oncol 2001;83:355-62.
Irving JA, Catasus L, Gallardo A et al. Synchronous endometrioid carcinomas of the uterine corpus and ovary: alterations in the b-catenin (CTNNB1) pathway are associated with independent primary tumors and favorable prognosis. Hum Pathol, 2005;36:605–19.
Ulbright TM, Roth LM. Metastatic and independent cancers of the endometrium and ovary: a clinicopathological study of 34 cases. Hum Pathol, 1985;16:28-34.
Scully RE, Young RH, Clement PB. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. Atlas of tumor pathology. Armed Forces Institute of Pathology, Bethesda, 1998.
Yang YH, Chen RJ, Lin MC, Cheng SP, Ting-Chen Chang TC. Synchronous primary ovarian and endometrial cancer with a fair prognosis in a young woman. Taiwan J Obstet Gynecol 2010;49:97-100.
Lin YC, Chu TY, Ding DC. Synchronous primary ovarian granulosa cell tumor and endometrial cancer. Taiwan J Obstet Gynecol 2011;50:546-8.
Rodolakis A, Thomakos N, Akrivos N et al. Clinicopathologic insight of simultaneously detected primary endometrial and ovarian carcinomas. Arch Gynecol Obstet 2012;285:817–21.
Abeler VM, Royne O, Thoresen S, Danielsen HE, Nesland JM, Kristensen GB. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology 2009;54:355-64.
Hendrickson MR, Tavassoli FA, Kempson RL et al. Mesenchymal tumours and related lesions. In Tavassoli FA & Deville P(eds.). Pathology and genetics of tumours of the breast and female organs. Lyon: IARC Press,2003,233-44.
Kondi-Paphitis A, Smyrniotis B, Liapis A, Kontoyanni A, Deligeorgi H. Stromal sarcoma arising on endometriosis. A clinicopathological and immunohistochemical study of 4 cases. Eur J Gynaecol Oncol 1998;19:588-90.
Yantiss RK, Clement PB, Young RH. Neoplastic and pre-neoplastic changes in gastrointestinal endometriosis: a study of 17 cases. Am J Surg Pathol 2000;24:513-24.
Hiroaki F, Toshiharu M, Manabu Y et al. Genetics of synchronous uterine and ovarian endometrioid carcinoma: combined analyses of loss of heterozygosity, PTEN mutation, and microsatellite instability. Hum Pathol 2002;33:421-8.
Uccella CS, Melton JL, Bergstralh EJ et al. Risk Factors for Developing Multiple Malignancies in Patients with Endometrial Cancer. Int J Gynecol Cancer 2011;21:869–901.
Kim MK, Sang Yong Song SY, Do IG et al. Synchronous gynecologic malignancy and preliminary results of Lynch syndrome. J Gynecol Oncol 2011;22:233-8.
Walsh CS, Blum A, Walts A et al. Lynch syndrome among gynecologic oncology patients meeting Bethesda guidelines for screening. Gynecol Oncol 2010;116:516-21.
Herrinton LJ, Voigt LF, Weiss NS, Beresford SAA,Wingo PA. Risk factors for synchronous primary endometrial and ovarian cancers. Annals of Epidemiology 2001;11:529–33.
Xue WC, Cheung AN. Endometrial stromal sarcoma of uterus. Best Practice & Research Clinical Obstetrics and Gynaecology 2011;25:719–32.