Synchronous endometrioid carcinoma of the uterus and ovaries

Case contributed by Dr Katia Kaplan-List

Presentation

Post menopausal bleeding.

Patient Data

Age: 66
Gender: Female

23 cm complex cystic and solid mass arising from the right hemipelvis and involving the uterus and bilateral ovaries. Abdominal and pelvic ascites.

CT obtained 1 year prior for abdominal pain did not demonstrate any pelvic abnormality (incidentally included distended gallbladder with a gallstone).

There is a massive solid, cystic, and multiseptated mass within the right hemipelvis, with cranial extension into the abdomen, where it abuts the inferior aspect of the liver. This appears to be right adnexal/uterine in origin. The left ovary is poorly evaluated.

Patient underwent TAH/BSO. Pathology revelaed adenocarcinoma, endometrioid type, FIGO grade 2, involving the uterus (with invasion of the outer half of the myometrium), bilateral ovaries, left fallopian tubea, right parametrium and right pelvic sidewall.  

 

The carcinoma involving right ovary, uterus, left fallopian
tube and left ovary appears similar throughout, consisting of an
endometrioid type adenocarcinoma. Immunostains performed on the right
ovarian tumor are positive for CK7 and Pax8, and negative for CK20 and
CDX-2. This excludes a metastatic colon cancer, and is supportive of a
mullerian derived adenocarcinoma. This may represent synchronous
primary adenocarcinomas involving right ovary and endometrium. However,
it may represent metastasis and if metastatic, an endometrial primary
with metastasis to ovary is favored. This is due to the presence of a
precursor lesion in the endometrium, atypical complex hyperplasia.


Also, the deep invasion of myometrium and foci suspicious for
lymphovascular invasion favor metastasis. The staging for endometrial
primary with metastasis to ovaries and parametrial involvement would be:
pT3b, NX. If synchronous primaries, the endometrial cancer staging
would not change. The staging for ovarian primary with extension to
right pelvic side wall (no malignant cells in pelvic washing) would be:
pT2b, NX.

Case Discussion

Surgical findings included a large right ovarian mass filled with purulent, mucinous and caseous like fluid, adherent to pelvic side walls, ileum and sigmoid. Omentum was grossly normal, enlarged left ovary with thin adhesions to left pelvic sidewall, small left hydrosalpinx, no ascites. Small anteverted uterus and long narrow cervix. No peritoneal studding. Frozen section of the pelvic mass: Adenocarcinoma favoring endometroid origin

Synchronous endometrioid carcinoma of the uterine corpus and ovary is an uncommon but well recognized entity. Diagnosis as either a separate independent primary or as a metastatic tumor requires careful consideration of a number of gross and histological features.

Patients with synchronous endometrioid tumors of the endometrium and ovary are generally younger than reported for either endometrial adenocarcinomas or ovarian adenocarcinomas. They tend to be low grade and early stage and are frequently associated with endometriosis. The prognosis of endometrioid type carcinomas is better than other histological types of carcinoma.

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Case information

rID: 43033
Case created: 19th Feb 2016
Last edited: 20th Feb 2016
System: Gynaecology
Inclusion in quiz mode: Included

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