SURGICAL DILEMMA: SYNCHRONOUS CANCER OR METASTASIS?

Introduction According to the International Agency for Research on Cancer (IARC), 225,500 women worldwide are diagnosed with ovarian cancer each year and more than 140,000 of them die. The disease is not widespread, but is the fifth leading cause of death. This clinical case presents a patient with endometrioid adenocarcinoma of the right ovary and endometrioid adenocarcinoma of the uterine corpus with low adherence to treatment. [15] Three variants of the course of the disease have been considered: malignization of endometriosis, synchronous ovarian and uterine body cancer, and metastasis of uterine body cancer to the ovary. In the literature there is a description of cases of malignization of endometriosis foci. Studies have shown that endometriosis is associated with an increased risk of developing certain histotypes of ovarian adenocarcinoma. Synchronous endometrial and ovarian cancer is found in 3-10% of cases. [14] Many works have been devoted to the verification of distant metastases of breast cancer to the ovaries by transvaginal ultrasound. The topic of image features of metastases to the ovary in endometrial cancer, as well as detection of masses in synchronous primary tumors of the endometrium and ovaries remains poorly studied. The authors concluded that the occurrence of these tumors was random, which is also rare. These type of clinical cases have never been presented in the foreign and Russian literature before. This fact emphasizes the importance of studying such rare clinical cases for a better understanding of pathogenesis and development of effective treatment strategies. Case description. The clinical case describes a variant of endometrioid adenocarcinoma of the ovary and endometrioid adenocarcinoma of the uterus, which occurred in a patient with an interval of three years. The stages of diagnosis, surgical treatment, pathological examination results, as well as the woman's refusal of further treatment are presented. Conclusion. The clinical case demonstrates how a diagnostic dilemma arising after the primary surgery for an ovarian tumor remains unresolved due to the patient’s refusal of further treatment. The subsequent detection of endometrial carcinoma only exacerbates the uncertainty: is this a distant metastasis, a second primary tumor, or a manifestation of a general predisposing background (endometriosis)? This case emphasizes that even successful surgical intervention does not always resolve fundamental questions of oncological diagnosis, which require comprehensive verification. Keywords:endometrioid adenocarcinoma of the ovary, endometrioid adenocarcinoma of the uterine corpus, synchronous cancer, endometriosis.