{"paper_id":"880f4954-f1a2-486f-9aea-8888de7ce7c9","body_text":"REV.CHIM.(Bucharest) ♦ 70 ♦ no. 12 ♦ 2019                                                  4360                                                   http://www.revistadechimie.ro \n \nSynchronous Primary Ovarian and Endometrial  \nCarcinomas in a Young Patient \nCase report and literature review \n \n  \nCIPRIAN LAURENTIU PATRU1#, MARIUS CRISTIAN MARINAS2*#, ILEANA DROCAS1,  \nFLORENTINA TANASE1, TIBERIU STEFANITA TENEA COJAN3#, GABRIEL FLORIN RAZVAN MOGOS3#, \nANA MARIA IFRIM PREDOI3, VLAD DUMITRU BALEANU4#, DRAGOS VIRGIL DAVITOIU5#, \nRAZVAN-GRIGORAS CAPITANESCU1# \n1University of Medicine and Pharmacy of  Craiova, Obstetrics and Gynecology Department, 2 Petru Rares Str., 200349, \nCraiova, Romania \n2University of Medicine and Pharmacy of Craiova, Anatomy Department, 2 Petru Rares Str., 200349, Craiova, Romania \n3University of Medicine and Pharmacy of Craiova, General Surgery Department, 2 Petru Rares Str., 200349, Craiova, \nRomania \n4University of Medici ne and Pharmacy of Craiova, Surgery Department, Clinical Emergency Hospital St. Pantelimon, \n340-342 Pantelimon Road, 021659, Bucharest, Romania \n5 University of Medicine and Pharmacy of Bucharest, Surgery Department, Clinical Emergency Hospital Sf. Pantelim on, \n340-342 Pantelimon Road, 021659, Bucharest, Romania \n \nSynchronous primary ovarian and end ometrial carcinomas is  a rare  condition encountured in \nclinical practic e, especially in young patients with history  of endometriosi s. The most frequent  \nhistopatological subtype is endometrioid carcinoma. We present a case of a 36 -years old patient \nadmitted in the Emergency Department for lower abdominal pain and abnormal uterine bleeding. \nThe c linical and u ltrasound examination diagnosed bilateral ovarian cystic  tumors, a normal \nuterine structure and no abdominal fluid colection . Serum levels of  ROMA score was performed \nwith normal value. The International Ovarian Tumor Anal ysis ( IOTA) criteria used for ovarian \ntumors scoring diagnosed a 55% probability for malignant tumors. Laparotomy was performed with \nprelevation of peritoneal fluid for citology . After  right anexectomy  was performed, the \nintraoperative histopathological examination  diagnosed endometrioid ovarian carcinoma . Left \nanexectomy and total hysterectomy with omentectomy and multiple peritoneal biopsy  was further \nperformed. The final histopathological examination confirmed endometr oid carcin oma in both \novaries and endometrial tissue.  \n \nKeywords: synchronous genital carcinomas, endometrioid subtype, endometriosis \n \n \nRecent literature shows that synchronous primary ovarian and endometrial carcinoma is the most frequent encountered \ndiagnosis in case of synchronous reproductive genital tumours.     Coexisting carcinomas of the endometrium and ovaries \nwere described in 10% of the ovarian and 5% of the endometrial tumors [1-3], the endometrioid carcinoma being most \nfrequently reported. \n Patients with synchronous primary disease have better prognosis compared with patients with single disease and \nassociated metastasis. The diagnostic accuracy in case of synchronous primary genital tumours is very important because \nit changes the treatment care [4-7]. \nSince 1985, Woodruff et al [8 ] defined that two or more primary tumors that occur closely in time in a patient are \ntermed as synchronous tumors and they can arise in the same or different site with different morphologies or in different \nsites with the same morphology. \nZaino et al  [1] described that synchronous genital carcinomas w ere misdiagnosed as FIGO stage III - endometrial \ncarcinoma or FIGO stage II - ovarian carcinoma. \nImmunohistochemistry and DNA flow cytometry w ere used for the distinction of primary tumours with the same \nhistologic type . The histopathological criteria described by Scully et a l [9] were used to differentiate between \nindependent primary cancers and single malignant tumors associated with metastasis (Table 1). \n \n \n \n \n \n*email: cristi_marinas84@yahoo.com, Phone: (+40)251–599 228                                   # Authors with equal contribution and share first authorship \n \n\nREV.CHIM.(Bucharest) ♦ 70 ♦ no. 12 ♦ 2019                                                  4361                                                   http://www.revistadechimie.ro \n \n \n \nTable 1 \nENDOMETRIOID TUMORS OF THE OVARY AND ENDOMETRIUM \n \n \n \n \nExperimental part \n This paper reports a case of a 36 years old patient hospitalized in the Obstetrics and Gynecology Department, \nEmergency County Hospital from Craiova, for pelvic pain and abnormal uterine bleeding.  Seven years before being \nadmitted to the hospital  the pacient had a caesarean section delivery for a macrosome fetus.  \nThe clinical gynecological examination revealed a normal uterine cervix with minimal vaginal bleeding, a retroverted \nposition of the uterus with normal diameter, regulate surface and normal consistence. We diagnosed moderate pain to \ncompression and mobilisation  of the uterus , a bilateral anexial tumor, with elastic consistence and intense pain. The \ntransvaginal ultrasound examination confirmed bilateral ovarian tumors (Fig 1). \n \n \n \n \nFig 1. A-Right ovarian tumor with solid and liquidian content.  \nB-Left ovarian tumor with liquidian content \n \n  \nBiological blood samples and thoracic X -ray were normal. We performed specific ovarian tumor markers CA125, \nHE4, β-HCG, CA15-3, CA19-9 and CEA with normal values. \nComputer Tomography (CT)  with contrast substance was performed. This investigation diagnosed  2 heterogenous \nmasses of 8/6 cm and 7,4/6,6 cm with fluid density and high marginal captation, the uterus with heterogenous captation \nand no lymphatic invasion. \n Laparotomy was performed. Peritoneal fluid sample for citology was prelevated and right anexectomy was performed. \nThe intraoperative hystopathological examination diagnosed endometrioid ovarian carcinoma.  Left anexectomy and \ntotal hysterectomy with  infracolic omentectomy and multiple peritoneal biopsy  was further performed . The \nhystopathological examination confirmed endometroid carcinoma in both ovarian and endometrial tissue. \nThere were no postoperative complications and the patient was discharged on day 6. On endometrial probes, the final \npathological reports described well diferentiated (G1) endometrioid carcinoma with ½ myometrial invasion  (Fig 2). \nModerate well diferentiated (G2) endometrioid carcinoma was also described on the ovarian probes (Fig 3 and Fig 4). \nPeritoneum and omentum biopsy samples were normal. The patient was referred to Oncology Department for specific \ntreatment. \n\n\nREV.CHIM.(Bucharest) ♦ 70 ♦ no. 12 ♦ 2019                                                  4362                                                   http://www.revistadechimie.ro \n \n \nFig 2. Right ovary-HE (Hematoxylin–Eosin staining) endometroid moderate well  \ndifferentiated carcinoma: A) secretory type, HE staining x2.0; B) areas of scuamous metaplasia, \n HE staining x2.5; C) secretory type, HE staining x20 ; D) areas of scuamous metaplasia, HE staining x2.5 \n \n \n \nFig 3. Left ovary-HE (Hematoxylin–Eosin staining) endometroid moderate well differentiated carcinoma: \nA) secretory type, HE staining x2.5; B) secretory type, HE stainig x20; C) areas of endometriosis, \nB) HE staining x2.5; D) areas of endometriosis, HE staining x2.5 \n \n \nFig 4. Uterus-HE (Hematoxylin–Eosin staining) endometrioid well differentiated adenocarcinoma: \nA) ½ myometrial invasion and area of endometriosis, HE staining x2.5 B);  \nB) ½ myometrial invasion and area of endometriosis, HE staining x5; C) HE staining x5. \n \nResults and discussions  \nIn our case presentation the diagnosis of synchronous primary endometrial and ovarian cancer was made in a young \npatient. Most studies reported this condition in postmenopausal woman [2,3]. Other authors concluded that patients who \ndevelop synchronous primary endometrial and ovarian cancer are younger than patients who develop only endometrial \nor ovarian cancer [10], and the signs or symptoms are similar to independent endometrial or ovarian cancer.  \nThe most common symptoms are abnormal uterine bleeding (65%), the presence of abdominal masses (26%) and \nabdominal pain (40%). In our case we found similar symptoms. Eifel et al. [11] reported a mean age of 41 years old at \ndiagnosis of the endometrioid cancer, in contrast with Gynecologic Oncolog y Group who reported a mean age of 49 \nyears old [1]. \nStudies examining young females (age less than 45 years) diagnosed with endometrial cancer, reported that 10-29% \nwere diagnosed with synchronous ovarian cancers. [12,13]. \n\n\nREV.CHIM.(Bucharest) ♦ 70 ♦ no. 12 ♦ 2019                                                  4363                                                   http://www.revistadechimie.ro \n \nEifel et al. [11] concluded that the role of estrogen in case of synchronous genital cancer should be furder evaluated \nand the response of the uterine corpus, fallopian tubes and ovarian epithelium as a morphologic unit could explain the \ndevelopment of synchronous endometrioid tumors in different components of the mullerian system.  \n In our case, the final histological probes confirmed ovarian endometriosis. This disease is sustained by other authors \nas a high-risk factor for ovarian epitelial cancer [14-16]. Accordind to Kurman [ 17] carcinomas associated with \nendometriosis are mostly located at the ovarian sites. He described that the most frequent histological type associated \nwith endometriosis is the clear cell endometrioid carcinoma.  Same authors [17] described a dualist pathway for \nepithelial ovarian cancer and divided t umors in two groups: Tip I (low-grade tumors) and Tip II (high-grade tumors) \n(Table 2).  \n \nTable 2 \nPATHWAY FOR EPITHELIAL OVARIAN CANCER  \nDESCRIBED BY KURMAN \nTip I (low-grade tumors) TIP II (high-grade tumors) \nLow-grade serous High-grade serous \nLow-grade endometrioid Low-grade endometrioid \nClear cells Malignant mixed mesodermal \nMucinous carcinomas Undifferentiated carcinomas \n \nMany authors [18 -20] described that the mutation in ARID1A or loss of BAF250a expression  are the most \nencountered genetic disorders asociated with endometriosis . They  concluded that this condition is more frequent in \nclear cell carcinomas than epitelial ovarian carcinomas.  Mingels et al  [21] analized histological samples from 186 \npacients diagno sed with epithelial ovarian cancer and discover ed high prevalence of atypical hyperplasia in the \nendometrium, and reports in 81 pacients(44%) endometrial lesion who was premalignant in 58(31%) pacients and \nmalignant in 6(3%), primary endometrial carcinoma. Same authors reported a higer body mass index (BMI) in pacients \nwith atypical endometrial hyperplasia in comparation in pacients with normal  endometrium, and performed genetical \ntests who described BRCA mutation carriers in both groups. \nIn this study we didn’t performed imunohistochemical analysys  but the previous study remarks that the \nimmunexpression of EGFR, HER 2 -neu and ki 67 was correlated with tumor type and grade differentiation and no \nassociation with the clinical parameters [22]. \nRegarding the immunexpresion of p53 and p16, Marinaș et.al [20] reported in a series of 24 selected ovarian tumors, \nthat p53 immunostaining was present in all borderline tumors and 85% of carcinomas, the highest PI being observed in \nhigh-grade carcinomas; p16 immunexpresion was identified in 75% of malignant and borderline tumors. He concluded \nthat the stain had the highest values in high-grade carcinomas and borderline tumors. \nIn females diagnosed with EOC  (endometrial ovarian cancer), the presence of concomitant endometrial \npremalignancy has to be taken into account. Most likely, concurrent atypical hyperplasia represents a premalignant stage \nof synchronous endometrioid carcinoma [23]. \nConservative surgery can be performed in patients diagnosed in the early stages of endometrial ovarian cancer \n(EOC), sparing the contralateral ovary and uterus [24-26]. \nSurgical treatment is the main treatment for endometrial and ovarian cancers.  The intervention involves \nhysterectomy, bilateral salpingo-oophorectomy, omentectomy and appedenctomy [27,28]. \nAyhan et al concluded that the stage of the ovarian cancer and the grade of the endometrial cancer are important \nprognostic factors [29,30]. \nSome authors argue the use of combined hormonal contrace ption in females with  endometriosis as a \nchemopreventive factor against gynaecological synchronous malignancies [31-35]. \nGungor et al [36] reported that ovarian and endometrial synchronous cancers were the most frequent synchronous \ncancers with a 77% survival rate in 21 patients diagnosed with synchronous gynaecological cancers.  \nSynchronous tumours of the ovary and endometrium have good prognosis especially in the early stages. The survival \nrates at 5 and 10 years are 86% and 80%. They depend on the FIGO stage, tumor histology and treatment strategies [37-\n40]. \n \nConclusions  \nIt is difficult to diagnose synchronous primary ovarian and endometrial cancers before surgery. This condition is rare \nbut the diagnosis should be taken into consideration in case of abnormal uterine bleeding associated with ovarian tumors.  \nIn early stages,  the prognosis of synchronous primary ovarian and endometrial cancers  is significantly improved \ncompared to metastatic disease. For the metastatic group there is a higher recurrence risk and frequently, the adjuvant \ntherapy is needed. \n \n \n \n\nREV.CHIM.(Bucharest) ♦ 70 ♦ no. 12 ♦ 2019                                                  4364                                                   http://www.revistadechimie.ro \n \nReferences \n 1.ZAINO, R., WHITNEY, C., BRADY, M., DEGEEST, K., BURGER, R.A., BULLER. R.E . Simultaneously detected endometrial and ovarian \ncarcinoma – a prospective clinicopathologic study of 74 cases: a gynecologic oncology group study. Gynecol Oncol. 2001 Nov, 83 (2), p 355-62. \n2. SOLIMAN, P.T., SLOMAVITZ, B., BROADDUS, R., SUN, C.C., OH, J.C ., EIFEL, P.J., GERSHENSON, D.M., LU, K.H . Synchronous \nprimary cancers of the endometrium and ovary: a single institution review of 84 cases. Gynecol Oncol. 2004 Aug. 94 (2). p456-62.  \n3. LOU, H.M., LOU, H.K., WU, M.J. Synchronous primary cancerof the endometrium and ovary. Chin J Oncol. 2006 Aug. 28 (8). p.617-20. \n4. CHIANG, Y.C., CHEN, C.A., HUANG, C.Y., HSIEH, C.Y., CHENG, W.F. Synchronous primary cancers of the endometrium and ovary.Int J \nGynecol Cancer, 2008, 18 (1), p. 159-64. \n5. Woodruff, J.D., Solomon, D., Sullivant, H,. Multifocal disease in the upper genital canal. Obstet Gynecol, 1985, 65 (5), p.695-8. \n6. LUCRETIU, R, CARSOTE , M, PREDESCU, AM , TENEA COJAN, TS, SOCEA, B , BALEANU, VD, POPESCU, M, IONOVICI, N, \nALBULESCU, DM. Rev. Chim. (Bucharest), 69, no. 12, 2018. p.3483-3485.    \n7. TENEA COJAN, TS, RADU, L, DAVITOIU, D, VLADU, IM, BALEANU, VD, CLENCIU, D, ENE, CG, SOCEA, B. Rev. Chim. (Bucharest), \n69,  no.10, 2018. p.2677-2681. \n8. ENE, CG, MITROI, M, VLADU, IM, RADU, M, TENEA COJAN, TS, PREDESCU, AM, BUNESCU, MG. Rev. Chim. (Bucharest), 70,  no.6, \n2019. p.2108-2111. \n9. SCULLY, R.E., YOUNG, R.H., CLEMENT. P.B ., Tumors of the ovary, maldeveloped gonads, fallopian tube and broad ligament. Atlas of \ntumor pathology. Bethesda, MD: Armed Forces Institute of Pathology, 1998. \n10. WILLIAMS, M.G., BANDERA, E.V., DEMISSIE, K., RODRÍGUEZ -RODRÍGUEZL. Synchronous primary ovar ian and endometrial \ncancers. A population-based assessment of survival. Obstet Gynecol., 113, no.4, 2009. p.783-9.  \n11. EIFEL, P., HENDRICKSON, M., ROSS, J. BALLON, S., MARTINEZ, A., KEMPSON, R. Simultaneous presentation of carcinoma involving \nthe ovary and the uterine corpus. Cancer. 50, no.1, 1982. p.163-70.  \n12. YAMAZAWA, K., SEKI, K., MATSUI, H., KIHARA, M., SEKIYA, S . Prognostic factors in young women with endometrial carcinoma: a \nreport of 20 cases and a review of the literature. Int J Gynecol Cancer. 2000 ;10(3), p.212-22. \n13. EVANS-METCALF, E.R., BROOKS, S.E., REALE, F.R., BAKER, S.P . Profile of women 45 years of age and younger with endometrial \ncancer. Obstet Gynecol. 1998, 91(3). p.349-54.  \n14. KOBAYASHI, H., SUMIMOTO, K., MONIWA, N., ARISAWA, K., TERAO, T . Risk of developing ovarian cancer among women with \novarian endometrioma: a cohort study in Shizuoka, Japan. Int J Gynecol Cancer. 17(1). 2007. p.37–43. \n15. KIM, H.S., KIM, T.H., CHUNG, H.H., SONG, Y.S. Risk and prognosis of ovarian cancer in women with endometriosis: a metaanalysis. Br J \nCancer. 110(7), 2014. p.1878-90. \n16. SARASWAT, L., AYANSINA, D., COOPER, K.G., BHATTACHARYA, S., HORNE, A.W., BHATTACHARYA, S. Impact of \nendometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG . Jan;125(1), 2018. p.64-72.  \n17. KURMAN R,J, SHIH, IEM . The dualistic model of ovarian carcinogenesis: revisited, revised, and expanded.  Am J Pathol . 2016 \nApr;186(4):733-47. \n18. SCARFONE, G, BERGAMINI, A, NOLI, S, VILLA, A, CIPRIANI, S, TACCAGNI, G,  VIGANO, P, CANDIAMI, M, PARAZZINI, F, \nMANGILI, G. Characteristics of clear cell ovarian cancer arising from endometriosis: a two center cohort study. Gynecol Oncol. 2014;133(3):480-\n4. \n19. AYHAN, A, MAO, T,L, SECKIN, T, WU, C,H, G UAN, B, OGAWA, H, FUTAGAMI, M, MIZUKAMI, H, YOKOYAMA, Y, KURMAN, \nR,J, SHIH, LEM. Loss of ARID1A expression is an early molecular event in tumor progression from ovarian endometriotic cyst to clear cell and \nendometrioid carcinoma. Int J Gynecol Cancer. 2012; 22(8):1310-5. \n20. STAMP, J,P, GILKS, C,B, WESSELING, M, ESHRAGH, S, CEBALLOS, K, ANGLESIO, M,S, KWON, J,S, TONE, A, HUNTSMAN, D,G, \nCAREY, M,S . BAF250a Expression in atypical endometriosis and endometriosis -associated ovarian cancer. Int J Gynecol Cancer.2016; \n26(5):825-32. \n21. MINGELS, M,J, MASADAH, R, GEELS, Y,P, OTTE-HÖLLER, I, DE KIEVIT, I,M, VAN DER LAAK, J,A, VAN HAM, M,A, BULTEN, \nJ, MASSUGER, L,F.High prevalence of atypical hyperplazia in the endometrium of patients with epithelial ovarian cancer.Am J Clin Pathol. 2014 \nAug; 142(2):213-21.  \n22. MARINAŞ, M,C, MOGOŞ, G, CIUREA, R, MOGOŞ, D,G. EGFR, HER2/neu and Ki67 immunoexpression in serous ovarian tumors. Rom J \nMorphol Embryol. 2012; 53(3):563–567. \n23. MARINAŞ, MC, MOGOŞ, DG, SIMIONESCU, CE, STEPAN, A, TĂNASE, F.  The study of p53 and p16 immunoexpression in serous \nborderline and malignant ovarian tumors Rom J Morphol Embryol. 2012; 53(4):1021–1025. \n24. TAFE, LJ, RIGGS, ER, TSONGALIS, GJ. Lynch syndrome presenting as endometrial cancer. Clin Chem.2014; 60(1):111-121. \n25. ESKANDER, RN, RANDALL, LM, BERMAN, ML,  TEWARI, KS, DISAIA, PJ, BRISTOW, RE . Fertility preserving options in patients \nwith gynecologic malignancies. Am J Obstet Gynecol. 2011; 205(2):103-110. \n26. VILCEA, ID, VASILE,  I, TOMESCU, P, et al, ”Loco-regional advanced colorectal cancer: diagnostic and therapeutic features”, Chirurgia, \nvol 103, Issue2, Pg 189-194, Mar-Apr 2008; \n27. COJAN, T.S. TENEA, VIDRIGHIN, C, CIOBANU , M, et al ”Breast -conserving surgery in breast cancer”, Chirurg ia, vol 107, issue 5, pg \n616-625, sept-oct 2012. \n28. VASILE, I, MIREA, C, VILCEA, ID, et al ”Esophago-digestive anastomosis dehiscence”, Chirurgia, Vol 104, Issue 3, pg 281-286, 2009. \n29. CORICI OM , TANASIE, C A, ALEXANDRU, DO, ”A morpho -functional study us ing PEP/LVET ratio and global longitudinal strain in \npatients with dilated cardiomyopathy”, Romanian Journal of Morphology and Embryology, Vol 59, Issue 1, pg 93-103, 2018. \n30.  SIGNORELLI, M, FRUSCIO, R, LISSONI, AA,  PIROVANO, C, PEREGO, P, MANGIONI, C . Synchronous early-stage endometrial and \novarian cancer. Int J Gynaecol Obstet.2008; 102(1). p.34-38. \n31. AYHAN, A, GUVENAL, T, COSKUN, F, BASARAN, M, SALMAN, MC . Survival and prognostic factors in patients with synchronous \novarian and endometrial cancers and endometrial cancer mestastatic to the ovaries. Eur J Gynaecol Oncol.2003; 24(2): 171-174. \n32. NEDELCUTA, RM, CALIN, G, BALEANU, VD, DAVITOIU, DV, VOICULESCU, DI, MIREA, CS, TENEA COJAN, TS, SOCEA, B, \nALEXANDRU, DO, CLENCIU, D, GHEORMAN, V,  UDRISTOIU, I, CALBOREAN, V, CIORA, CA. Rev. Chim. (Bucharest), 70,  no. 5, \n2019, p. 1698-1702. \n33. STANESCU, GL, NEDELCUTA, RM, DOP, D, DIACONU, R, CALIN, G, NICULESCU, EC, GHEONEA, C, STANESCU, R, \nANGHELINA, L, STANESCU, MR. Brain abscess of unknown etiology in a 2-year-old child: a case report.  Rom J Morphol Embryol 2015 , \n56(3). p. 1201–1204. \n \n \n\nREV.CHIM.(Bucharest) ♦ 70 ♦ no. 12 ♦ 2019                                                  4365                                                   http://www.revistadechimie.ro \n \n34. CLENCIU, D, TENEA COJAN, TS, DIJMARESCU, AL, ENE , CG, DAVITOIU, DV, BALEANU, VD,  CIORA, CA, SOCEA, B, \nVOICULESCU, DI, NEDELCUTA RM, CALBOREAN, V, GHEORMAN, V, VLADU,IM. Rev.Chim. (Bucharest),70, no.4, 2019, p. 1434-1438. \n35. KAUNITZ, AM. Oral contraceptives and gynecologic cancer: an update for the 1990s. Am J Obstet Gynecol.1992; 167 (Pt 2):1171-6. \n36. GUNGOR, T, PEKTAS, MK, USTUNYURT, E, MOLLAMAHMUTOGLU, L . Synchronous primary tumors of the female genital tract: a \nsingle center experience. Arch Gynecol Obstet. 279(5), 2009.  p.667-72. \n37. NEDELCUTA, R, BALEANU, VD, CIORA, C, CALIN, G, STANESCU, MR, DAVITOIU, DV, TENEA COJAN, TS, SOCEA, B, \nVOICULESCU, DI, ALEXANDRU, DO, STANESCU, R. Rev. Chim. (Bucharest), 70, no.5, 2019, p. 1859-1862.  \n38. GHEORMAN, V, DINESCU, VC, CRICIOTOIU, O, STANCA, D, CALBOREAN, V, MITA, A, MISCOCI, A, DAVITOIU, DV, \nBALEANU, VD, NEDELCUTA, RM, DINESCU, SN, DIJMARESCU, AL, VOICULESCU, DI, UDRISTO IU, I.  Rev. Chim. (Bucharest), 70, \nno. 4, 2019, p. 1406-1410. \n39. NEDELCUTA, R, POPESCU, M, CALIN, G. Digestive Manifestations in Wilms' Tumor.  NEUROGASTRO 2017 - MEETING OF THE \nROMANIAN SOCIETY OF NEUROGASTROENTEROLOGY WITH ROME IV REGIONAL CENTRAL EAST  EUROPEAN MEETING. \n2017, p. 200-204. \n40. EIFEL, PJ, ROSS, J, HENDRICKSON, M, COX, RS, KEMPSON, R, MARTINEZ, A. Adenocarcinoma of the endometrium. Analysis of 256 \ncases with disease limited to the uterine corpus: treatment comparisons. Cancer. 52(6), 1983. p.1026-31. \n \nManuscript received: 4.11.2019","source_license":"CC0","license_restricted":false}