{"paper_id":"8df76de9-ab81-46d0-bb0e-f633bcdb8800","body_text":"~ 96 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2020; 4(5): 96-98 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \n© Gynaecology Journal \nwww.gynaecologyjournal.com  \n2020; 4(5): 96-98 \nReceived: 24-06-2020 \nAccepted: 04-08-2020 \n \nDr. Anandita \nM.B.B.S. D.N.B Obstetrics and \nGynaecology, Department of \nGynaecological Oncology, Amrita \nInstitute of Medical Sciences, \nKochi, Kerala, India \n \nDr. Indu R Nair \nM.B.B.S. M.D., Department of \nPathology, Amrita Institute of \nMedical Sciences, Kochi, Kerala, \nIndia \n \nDr. Anupama Rajanbabu \nM.B.B.S. M.S., Obstetrics and \nGynaecology, MRCOG \nDepartment of Gynaecological \nOncology, Amrita Institute of \nMedical Sciences, Kochi, Kerala, \nIndia \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Anandita \nM.B.B.S. D.N.B Obstetrics and \nGynaecology, Department of \nGynaecological Oncology, Amrita \nInstitute of Medical Sciences, \nKochi, Kerala, India \n \nSynchronous type ii endometroid adenocarcinoma of the \novary and endometrium: A case report \n \nDr. Anandita, Dr. Indu R Nair and Dr. Anupama Rajanbabu \n \nDOI: https://doi.org/10.33545/gynae.2020.v4.i5b.689  \n \nAbstract \nObjective: The synchronous endometrial and ovarian cancer is a rare phenomenon with incidence of 1.4 to \n3.8%. Mostly in SEOC , the ovarian endometroid carcinoma arises in background of endometriosis with \nendometrial carcinoma with lower stage and lower grade in premenopausal age group. \nCase report: We are reporting a case  report of Synchronous type 2  endometrial and ovarian cancer \\ with \nan unusual presentation at later age of 70 , in postmenopausal  lady with higher grade of endometrial \ncarcinoma and higher stage of ovarian cancer and patient was treated with adjuvant chemotherapy followed \nby vault brachytherapy in view of Stage II B ovarian cancer and IA grade 3 endometrial cancer.  \nConclusion: The SEOC being a rare phenomenon with different therapeutic and prognostic considerations, \nand hence can be managed with multidisciplinary approach and regular follow up. \n \nKeywords: Synchronous endometrial ovarian cancer, endometrioid, endometriosis \n \nIntroduction  \nThe carcinoma in the uterus and ovary concurrently are found in 10% of ovarian cancer and in \n5% cases of endometrial cancer.  The synchronous presence of two independent primaries i.e \nendometrial and ovarian cancer in a patient at the time of diagnosis is known as \nSeoc(Synchronous Endometrial Ovarian Cancer ). In the present case report. we report a case of \nsynchronous type II endometrial and ovarian carcinoma. \n \nCase Presentation \nA 70 year old postmenopausal lady with diabetes and systemic hypertension presented to our \nOPD with complaints of  spotting per vaginum on and off since 8 months . She gave history of \nundergoing a laparotomy for removing uterus 11 years ago which was abandoned as she had \ndense adhesions in the pelvis and uterus and ovaries were not visible. After the unsuccessful \nlaparotomy she achieved symptom control of her AUB through medical management (Danazol)  \nand was asymptomatic till the present episode. \nOn clinical examination there was soft cystic mass of 8x 8 cm in the lower abdomen with same \nmass felt on vaginal examination. Ult rasonography showed endometrial thickness 29mm with \nnormal sized uterus with 8x 7 cm right adnexal cyst . Her tumor markers were within normal \nlimits {CA125 was 19.3 and CEA  3.1). Endometrial biopsy showed endometrioid carcinoma \nand Magnetic resonance imagi ng showed normal sized uterus with seedling fibroids and small \nhyperintense lesion in lower endometrium infiltrating inner myometrium. MRI also showed a  \nleft adnexal cyst of 9x9x7 cm with internal hemorrhage She underwent staging surgery and \nintraoperatively, dense adhesions were found in the pelvis. There was a 9x 10 cm left ovarian \nmass adherent to rectosigmoid and left pelvic wall . Uterus was buried under the adhesions. After \ncareful adhesiolysis, uterus and normal looking right ovary and tube was visual ized. A 2 x 2 cm \ntumor deposit was seen in the pouch of douglas. Complete staging including hysterectomy, \nbilateral salpingo oophorectomy, lymphadenectomy and omentectomy was done.  \nHistopathology examination showed an  irregular growth in the endometrium me asuring \n1.3x1x0.2cm and a polyp measuring 1cm. Right ovary showed a cyst 1.9cm in greatest \ndimension. Left ovary was cystically enlarged, with solid and haemorrhagic areas.  \n \n \n \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 97 ~ \nMicroscopy showed endometrium with a neoplasm composed of \ncells arranged in glandul ar, cribriform and papillary pattern.  The \ncells had moderate cytoplasm and vesicular nuclei with \nprominent nucleoli.  Many cells with clear cytoplasm were also \nnoted. Mitosis noted,1 -2/HPF. Luminal necrosis noted. The \nneoplasm was seen to infiltarte the inne r myometrium.  No \nLVE/MELF pattern were seen. Endometrium also showed a \nbenign polyp. Fig.1 \nSections from right ovary showed a neoplasm composed of cells \narranged in papillae, fused glandular, cribriform and focal solid \nareas (<5%). Lining cells are composed  of stratified, columnar \nto cuboidal cells with smooth luminal border, moderate \neosinophilic cytoplasm and mildly pleomorphic vesicular \nnucleus with small nucleoli. Numerous apoptotic bodies seen. \nLuminal necrosis and squamous morules were seen. Fig.2 \nLeft Ovary showed an endometriotic cyst. \nBilateral Fallopian tubes and omentum were free of tumour. \nLymph nodes were free of tumour,  whereas POD Deposit was \npositive for tumour. Endometrial carcinoma showed \nmorphological features of papillary carcinoma with hig h nuclear \ngrade and clear cells,  which suggested a type 2 carcinoma,  \nwhich was confirmed with the immunohistochemical positivity \nwith p53.ER was positive in 90% of tumour cells and PR in 70% \nof cells. \nRight ovarian carcinoma showed the typical morphology of \nendometrioid carcinoma with squamous morules and left ovary \nshowed an endometriotic cyst. \nOvarian carcinoma also showed p53 positivity with WT1 \nnegativity and intense ER and PR positivity, suggesting a high \ngrade endometrioid carcinoma (type 2). \nAs the end ometrial carcinoma was confined to inner \nmyometrium with no LV emboli and ovarian carcinoma was \nseen to be associated with endometrioisis,  they were considered \nas synchronous primary carcinomas. \nCase was discussed in multiple disciplinary tumor board and \nwas decided for adjuvant chemotherapy followed by vault \nbrachytherapy in view of Stage II B ovarian cancer and IA grade \n3 endometrial cancer.  \n \n \n \nFig 1: Histopathological appearance of carcinoma endometrium \n \n \nFig 2: Histopathological appearance of Carcinoma ovary \n \nDiscussion \nThe incidence of synchronous endometrioid cancer of both \novaries and endometrium is 1.4 to 3.8%. This being a rare \nphenomenon with different therapeutic and prognostic \nconsiderations, makes it important to distinguish from the \nmetastatic carcinoma. Endometrial cancer with synchronous \novarian cancer were more likely to be stage I -II disease, \nendometrioid or serous histology types, grade 1 -2 tumors, and \nsmall tumor size in Matsou et al. study [1]. \nIn most of the reports SEOC, the ovarian endometroid \ncarcinoma arises in background of endometriosis with \nendometrial carcinoma with lower stage and lower grade  [2]. \nThree case series of the women diagnosed with SEOC published \nby Markis et al. in 2017 had endometrioid subtype, grade 1, both \nin the ovarian and endometrial component [2]. \nAskin et al. in their case report have reviewed that 63 citations \nwere identified reporting on young women with SEOC, defined \nfor the purpose of this review as <50 years of age or \npremenopausal. and most cases of EC and ovarian cancer were \nearly stage tumors with 72% of EC cases classified as FIGO \nstage I disease and 70% of ovarian cancer cases cla ssified as \nFIGO stage I disease [3]. \nA population-based retrospective a nalysis of SEOCs by Matsuo \net al.  showed that among the endometrial cancer cohorts, \nsynchronous primary endometrioid endometrial and ovarian \ntumors accounted for majority of the cases with 21.8% \naccounted for the high-grade (grades 2 and 3) tumors [1]. \nThis case report has unusual presentation of SEOC at later age \nof 70, in postmenopausal lady with higher grade of endometrial \ncarcinoma and higher stage of ovarian cancer when compared \nwith the above mentioned review of literature.  \nPTEN and CTNBB1 mutations are found more frequently in \nSEOC than p53. In the study by ishikawa et al. the frequencies \nof somatic mutations in  TP53, PTEN, CTNNB1, KRAS, \nand POLE were 3 (37.5%), 2 (25.0%), 3 (37.5%), 0 (0.0%), and \n5 (62.5%) of 8 cases in ovarian tumors and 3 (37.5%),  2 \n(25.0%), 3 (37.5%), 1 (12.5%), and 5 (62.5%) of 8 cases in \nendometrial tumors, respectively [4]. \nIn this case report both ovarian and endometrial tumors were \np53 positive on Immunohistochemistry and P53 positivity is rare \nin SEOC. The histological grade  is important because tumor \nwith higher grade can be more aggressive with higher chance of \nrecurrence.  \nPresent report is to highlight a synchronous ovarian and \nendometrioid carcinoma with aggressive Type II features \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com \n~ 98 ~ \npresenting at an older age and higher s tage than previously \nreported.  \n \nConclusion \nSynchronous ovarian and endometrioid carcinoma usually \npresents at premenopausal age group with lower grade and \nstage. But in case of an unusual presentation as in this case, it \ncan be managed with multidisciplin ary approach and regular \nfollow up.  \n \nConflict of interest disclosure: All authors declare no conflict \nof interest. \n \nReferences \n1. Matsuo K, Machida H, Blake EA , Holman LL, Rimel BJ, \nRoman LD  et al . Trends and outcomes of women with \nsynchronous endometrial an d ovarian cancer. Oncotarget 9, \n2018, 28757-28771.  \n2. Makris GM, Manousopoulou G, Battista MJ, Salloum I, \nChrelias G, Chrelias C  et al. Synchronous Endometrial and \nOvarian Carcinoma: A Case Series.  Case Rep Oncol . 2017; \n10(2):732-736. Published 201 7 Aug 9. \ndoi:10.1159/000479501 \n3. Dogan A, Schultheis B, Rezniczek GA, Hilal Z, Cetin C, \nHaeusler G et al . Synchronous endometrial and ovarian \ncancer in young women: case report and review of the \nliterature. Anticancer research. 2017; 37(3):969-78. \n4. Ishikawa M, Nakayama K, Nakamura K, Ono R, Yamashita \nH, Ishibashi T  et al. High frequency of POLE mutations in \nsynchronous endometrial and ovarian carcin oma. Human \npathology. 2019; 85:92-100.","source_license":"CC0","license_restricted":false}