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Synchronous Ovarian and Endometrial Malignancies
Abstract
Synchronous ovarian primaries are infrequently found in patients with endometrial cancer. Although numerous investigators have examined the characteristics of these women, most include patients with tumors of similar histology, which may simply represent ovarian metastases. To overcome this problem, we present here patients found to have tumors of dissimilar histology. Of 499 patients with endometrial cancer undergoing primary surgery between 1980 and 1997, 18 (3.6%) were found to have endometrial and ovarian primaries of dissimilar histology. The median age was 64.2 years. Most had stage I, grades I and II, minimally invasive endometrial adenocarcinomas and stage IA mucinous or serous ovarian cystadenocarcinomas. Most ovarian tumors were either borderline or grades I and II. The 5-year actuarial disease-free (DFS) and cause-specific survivals of the entire group were 81.2% and 89.5%, respectively. Those with both stage I ovarian and endometrial primaries had a trend to a better DFS (100 versus 68.6%, p = 0.07) than did women with higher stage disease. Our data demonstrate that synchronous ovarian primaries of dissimilar histology are infrequently found in women undergoing surgery for endometrial cancer. These women seek treatment at a relatively advanced age, and have early-stage, low grade disease in both sites. Their outcome is favorable, particularly those with stage I disease in both sites.
... [30,31] Moreover, the treatment of one primary cancer does not compromise the treatment of the other primary cancer. [32] Especially in patients with unfavorable histologic types, high grade and/or advanced stage disease, required postoperative adjuvant treatment tailored to both tumors. [3,5,15,[17][18][19][20][21]30,[32][33][34][35][36] More specifically, postoperative adjuvant treatment in those patients includes: radiotherapy and/or chemotherapy. ...
... [32] Especially in patients with unfavorable histologic types, high grade and/or advanced stage disease, required postoperative adjuvant treatment tailored to both tumors. [3,5,15,[17][18][19][20][21]30,[32][33][34][35][36] More specifically, postoperative adjuvant treatment in those patients includes: radiotherapy and/or chemotherapy. [1,21,30,36] Postoperative adjuvant radiotherapy includes: external pelvic radiotherapy and/or brachytherapy. ...
... [39] Moreover, patients with synchronous primary endometrial and ovarian cancers have better overall survival compared with patients with single primary ovarian cancer. [30,32,35,39] The reason for the better overall survival of patients with synchronous primary endometrial and ovarian cancers, is not intuitively obvious. [16] Perhaps favorable prognosis related with the detection of patients at early stage and low grade disease. ...
... KEYWORDS: Adenocarcinoma, Endometrial, Ovarian, Synchronous INTRODUCTION: Synchronous endometrial and ovarian cancers are infrequently found with incidence rate of 2-8.5%. [1,2,3] They may have similar or different histologic appearances. Rare cases of papillary, serous, clear cell carcinomas and carcinosarcoma of endometrium with ovarian primary have been reported. ...
... Rare cases of papillary, serous, clear cell carcinomas and carcinosarcoma of endometrium with ovarian primary have been reported. [1,4] Patients with tumors of identical histology at both sites should be categorised as either two individual primaries or as primary at one site with metastasis at the other site. The diagnosis of synchronous ovarian and endometrial cancer is less in doubt when tumors have dissimilar histology, as majority of them are cases of metastasis to ovary from endometrial primary. ...
... The diagnosis of synchronous ovarian and endometrial cancer is less in doubt when tumors have dissimilar histology, as majority of them are cases of metastasis to ovary from endometrial primary. [1] CASE REPORT: A 51 year old female patient, P3L3, presented with complaints of lower abdominal mass, menorrhagia, irregular inter-menstrual bleeding and lower abdominal pain. The abdominal mass was of 20 weeks' size and was also felt per vaginum. ...
Rare instances of endometrial & ovarian cancers pre
senting at the same time
(synchronous) have been reported in literature with
their incidence rate ranging from 2-8.5%.
They may or may not share the same histologic featu
res. When they share identical histology, it
is difficult to categorize them as two independent pr
imaries or as one primary with metastasis
in the other.
Despite the difficulty, prognostication depends on t
his differentiation since two
independent primary tumors with identical histology c
arry a better prognosis than the other
category.
Molecular genetics may be the sole answer when suc
h a difficulty is encountered. We
present one such quizzical case of synchronous endom
etrial & ovarian adenocarcinomas with
similar histology occurring in a 51 year old female
.
... Women with multiple primary ovarian cancers were more likely than those with a single primary to be diagnosed with a well-differentiated or moderately differentiated tumor and less likely to have a tumor of unknown grade. These findings, which may result from heightened surveillance and more favorable stage of disease and tumor grade for patients with multiple primaries, were consistent with the studies of Sheu et al. 7 and Castro et al., 23 the latter of which examined only ovarian-endometrial combinations. Fishman et al. 14 observed no difference in grade between single and multiple primary ovarian cancers. ...
... Among patients with multiple primary cancers, Asian and Pacific Islander women were more likely to be diagnosed at an earlier stage than were white women. Castro et al. 23 and Sheu et al. 7 both reported an earlier stage at diagnosis of multiple primary ovarian cancers compared with a single primary cancer. In contrast, McGuire et al. 8 observed fewer localized multiple primary cancers than localized single primary cancers. ...
... Simultaneous presentation of ovarian and endometrial cancers is a well-recognized but uncommon diagnosis, accounting for 2-8.5% of endometrial cancer diagnoses. 23 Because ovarian and endometrial malignancies share similar characteristics, it can be difficult to determine whether each develops independently or whether one is a metastatic site of the other. 7,23 If the histology differs between the two sites, then two primaries definitely exist. ...
The current study describes the incidence of multiple primary ovarian malignancies by race and ethnicity among women in the United States during the period 1992-1997. The authors examined the most common primary cancer combinations and compared disease characteristics, such as sequence of occurrence and age at diagnosis of ovarian cancer among racial and ethnic groups. Women with multiple primary ovarian cancers tended to be older than those with a single primary ovarian cancer. Incidence also was higher in white women and in non-Hispanic women. Among women with multiple ovarian primaries, the ovarian cancer was most often diagnosed in the second of two tumors.
... Carcinoma of endometrium can occur simultaneously in about 10 percent of patients with ovarian carcinoma (Zaino R et al., 2001). Rare cases of uterine carcinosarcomas and leiomyosarcomas associated with ovarian carcinomas have been reported in literature (Iris M. Castro et al;2000). The identification of synchronous ovarian malignancies in women with endometrial carcinoma is complicated by the fact that the ovary represents a possible site of metastatic spread from the endometrium. ...
... Carcinoma of endometrium can occur simultaneously in about 10 percent of patients with ovarian carcinoma (Zaino R et al., 2001). Rare cases of uterine carcinosarcomas and leiomyosarcomas associated with ovarian carcinomas have been reported in literature (Iris M. Castro et al;2000). The identification of synchronous ovarian malignancies in women with endometrial carcinoma is complicated by the fact that the ovary represents a possible site of metastatic spread from the endometrium. ...
Synchronous primary carcinosarcoma of endometrium and primary serous carcinoma of ovary is an extremely unique event. We present a very rare case of Uterine Carcinosarcoma. synchronously presenting with Serous Carcinoma of the Ovaries in a 58-year-old.
... In our case both the ovarian and the uterine tumor were histologically low grade and low stage. Along with the above mentioned gross and histologic criteria, other special techniques can be used to differentiate 15,17 metastases from primary lesions. Concomitant tumors with exactly the same morphology arising in ovary and endometrium, especially the endometrioid carcinoma, will 18 show the same immunohistochemical expression patterns. ...
... But Halperin et al reported that 62.5% of synchronous primary endometrial and ovarian cancers can be classified by detection of ER and PR content and that 31.3% of synchronous primary endometrial and ovarian cancers can be identified by detecting 19 Bcl-2, which is positive in uterine cancer metastatic to ovary. Molecular profiling in synchronous endometroid and ovarian [15][16][17] cancers may aid in determining a differential diagnosis. ...
Abstract
Endometriosis is a common gynecologic problem. Malignant transformation of endometriosis, though a rare event, is well
documented. Synchronous endometrial and ovarian carcinoma either primary or metastatic is also uncommon. Here we report a case
of endometriosis with concurrent ovarian and uterine endometroid carcinoma.
Key words: Endometriosis, Malignant Transformation, Endometrioid Carcinoma, Synchronous Carcinoma
... In our case both the ovarian and the uterine tumor were histologically low grade and low stage. Along with the above mentioned gross and histologic criteria, other special techniques can be used to differentiate 15,17 metastases from primary lesions. Concomitant tumors with exactly the same morphology arising in ovary and endometrium, especially the endometrioid carcinoma, will 18 show the same immunohistochemical expression patterns. ...
... But Halperin et al reported that 62.5% of synchronous primary endometrial and ovarian cancers can be classified by detection of ER and PR content and that 31.3% of synchronous primary endometrial and ovarian cancers can be identified by detecting 19 Bcl-2, which is positive in uterine cancer metastatic to ovary. Molecular profiling in synchronous endometroid and ovarian [15][16][17] cancers may aid in determining a differential diagnosis. ...
Abstract
Accessory or ectopic breast tissue persisting from embryologic development is found in about 2-6% of females and 1-3% of males.
Hormonal stimulation at the time of menarche, pregnancy and lactation all directly influence the proliferation of breast tissue proper
and at the ectopic site. Patients with accessory breast tissue present in the reproductive age group usually. Presentation in menopause
is rare. We report a case of 51 years old post menopausal female who presented with the complaint of 5 x 7cm lump in right inguinal
region. Histopathology examination revealed it to be an ectopic breast tissue in the inguinal area. Interestingly fibrocystic changes
were also seen in the tissue. The patient was cured of the symptoms after surgical removal of the lump.
Key words: Ectopic Breast Tissue, Fibrocystic Disease, Post Menopausal Age
... Particularly in patients with increased risk for recurrence or at advanced stage disease, postoperative adjuvant treatment customized to both cancers is required [1][2][3][4]7,[12][13][14]16,26,[29][30][31]41,[43][44][45] . More specifically in those patients, postoperative adjuvant treatment includes radiotherapy and/or chemotherapy [1][2][3]12,16,41 . ...
... Patients with synchronous primary endometrial and ovarian cancers have 5 -year overall survival 85.9% and 10 -year overall survival 80.3% 11 . It is obvious that patients with synchronous primary endometrial and ovarian cancers have better overall survival than patients with single primary ovarian or endometrial cancer [1][2][3]10,41,43,45,58 . Moreover, patients with synchronous primary endometrial and ovarian cancers of endometrioid type have better overall survival than patients with non -endometrioid or mixed histologic types [1][2][3]10,41,45 . ...
Synchronous primary endometrial and ovarian cancers are relatively uncommon in general population. Although their pathogenesis still remains unclear, embryologic, hormonal, genetic or other phenomena may be responsible for the development of synchronous primary endometrial and ovarian cancers.
The most common symptoms and signs in those patients, are: abnormal uterine bleeding, abdominal/pelvic pain and abdominal/pelvic mass.
For most patients with synchronous primary endometrial and ovarian cancers, systematic surgical staging is the baseline therapy and includes: total abdominal hysterectomy with bilateral salpingo-oophorectomy, total omentectomy, appendectomy, pelvic and para-aortic lymphadenectomy, complete resection of all disease, biopsy of any suspected lesion and pelvic washings. Moreover, that therapeutic approach allows a more clear decision for stage related postoperative adjuvant therapy.
The role of postoperative adjuvant treatment in patients with synchronous primary endometrial and ovarian cancers, remains controversial. In most cases, postoperative adjuvant treatment should be individualized according to the risk of recurrence of each primary cancer. Particularly in patients with increased risk for recurrence or at advanced stage disease, required postoperative adjuvant treatment customized to both cancers.
Patients with synchronous primary endometrial and ovarian cancers have better overall survival than patients with single primary ovarian or endometrial cancer. Perhaps favorable prognosis associated with the detection of patients at early stage and low grade disease. Moreover, the clinical efficacy of the postoperative adjuvant treatment should be further investigated.
... The significance of postoperative adjuvant treatment in patients with synchronous primary endometrial and ovarian cancers, remains controversial [14,15,39]. However in most cases, postoperative adjuvant treatment should be individualized according to the risk of relapse of each primary cancer [2,39,40] Moreover, the treatment of one primary cancer does not compromise the treatment of the other primary cancer [2,41]. ...
... Prognostic factors for synchronous primary endometrial and ovarian cancers are: age, stage of ovarian cancer, grade of endometrial cancer and adjuvant treatment [43][44][45]. Patients with synchronous primary endometrial and ovarian cancers have 5-year overall survival 85.9% and 10 year overall survival 80.3%.14 Patients with synchronous primary endometrial and ovarian cancers have better overall survival than patients with single primary ovarian or endometrial cancer [1,2,9,39,41,43,46]. Moreover, patients with synchronous primary endometrial and ovarian cancers endometrioid type have better overall survival than patients with non-endometrioid or mixed histologic types [1,2,9,39,43]. ...
... Por nuestra experiencia, nos inclinamos a considerar estos casos de mejor pronóstico dada la alta supervivencia de las pacientes después de los tratamientos. Un número considerable de estudios retrospectivos evidencia que la supervivencia de las pacientes con tumores sincrónicos de ovario y de endometrio es mucho más favorable que la esperable para tumores me-tastatizados de endometrio o de ovario 1,8,9,[11][12][13] . La supervivencia alcanza el 66-100% a los 3 años 12,14 , marcadamente superior al 63% de los pacientes con carcinoma de ovario estadio II o el 42-63% de los pacientes con carcinoma de endometrio estadio III 2 . ...
... La aproximación terapéutica también es controvertida. Algunos autores consideran que el tratamiento quirúrgico es suficiente en los tumores grado I endometriodes 8,11 , mientras que otros son partidarios de terapias adyuvantes como la quimioterapia y la radioterapia, especialmente para tumores no endometriodes que suelen ser más agresivos. En nuestros casos se realizó cirugía con quimioterapia y/o radioterapia adyuvante según el estadio de las neoplasias de endometrio y ovario valoradas de forma independiente. ...
Synchronous primary cancers of the endometrium and ovary are found in 10% of women with ovarian cancer and 5% of women with endometrial cancer. The classification into synchronous primary cancers or metastasis has different consequences in the prognosis and treatment. But this classification is still difficult. We describe four cases from our service. Endometrioid cancers are the most frequent and have the best prognosis. The median age of the patients is younger than patients with metastasic tumours and the most common sign or symtom is abnormal uterine bleeding. Treatment is still controversial.
... Currently, distinguishing between a primary tumor with related metastatic lesions and independent primary tumors in-volves clinicopathologic interpretation based on multiple criteria including histologic type and grade (8 -11). In general, if tumors at different sites have dissimilar histologic features they are generally regarded as independently derived primary tumors (12). Alternatively, the two tumors may have a similar histologic appearance but could still represent independent tumors (13,14). ...
... To assess the ability of genetic analysis to accurately diagnose tumors with independent origins, we compared two diagnostically challenging scenarios in gynecologic oncology. One scenario is the occurrence of synchronous tumors of the ovary and endometrium (2,4,12,(21)(22)(23). This is not an infrequent occurrence-many patients with endometrioid cancer of the ovary have a concomitant endometrial tumor, and ovarian involvement of an endometrial cancer occurs in 5%-8% of patients at laparotomy (24 -26). ...
... Due to the low incidence of SEOC and the difficulty in establishing a preoperative diagnosis, along with the limitations of retrospective studies with small sample sizes, there is currently no unified standard or consensus for the treatment of SEOC. However, some studies suggest that for early-stage and low-grade SEOC patients, surgical treatment alone may lead to favorable outcomes (5,49,50). While there is no standardized treatment approach at present, these research findings provide valuable insights into SEOC treatment. ...
Synchronous endometrial and ovarian carcinoma (SEOC) is the most common combination of primary double cancer in the female reproductive system. The etiology and pathogenesis of SEOC remain unclear, and clinically, it is often misdiagnosed as metastatic cancer, affecting the formulation of treatment plans and prognosis for patients. This article provides a review of its epidemiology, pathological and clinical characteristics, risk factors, pathogenesis, diagnosis, treatment, and prognosis.
... There are no reports of the co-existence of seromucinous carcinoma of the ovary with mucinous carcinoma of the uterine corpus [15]. The prognosis of multiple gynecological cancers has been reported to be relatively good, since they are often distinct earlystage cancers, and the 5-year survival rate has been reported to be 85.9% [16][17][18]. However, only a few of these reports include advanced ovarian cancer. ...
Endometrioid carcinoma is the most common histological type of concurrent synchronous cancers of the uterus and ovary. Here we report a case of synchronous seromucinous carcinoma of the ovary and mucinous carcinoma of the endometrium with a literature review. A 51-year-old multiparous female complained of irregular bleeding and shortness of breath. Computed tomography revealed a large pelvic mass that consisted of cystic and solid components, a tumor of the endometrium, and a large amount of pleural effusion. An endometrial biopsy indicated adenocarcinoma, and adenocarcinoma cells were found in the pleural fluid. The patient with advanced ovarian cancer or endometrial cancer with massive pleural effusion received three courses of neoadjuvant chemotherapy (NAC) with paclitaxel and carboplatin followed by interval debulking surgery (IDS). The NAC was effective, and IDS was performed with no gross residual lesions. The post-operative diagnosis was seromucinous carcinoma of the ovary in FIGO (2014) stage IVA (ypT3cNxM1a) and mucinous carcinoma of the endometrium in FIGO (2008) stage IA (ypT1aNXM0). Three courses of postoperative TC therapy were performed, and maintenance therapy with Bevacizumab is ongoing. The patient is well without evidence of recurrence, sixteen months after surgery.
... Multiple synchronous gynecological lesions represent a relatively frequent occurrence in female patients suffering from ovary-associated malignant diseases (1)(2)(3)(4). Clinicians are often faced with the diagnostic dilemma of whether the simultaneously presented tumors arise independently or result from metastatic dissemination (5)(6)(7). Such a distinction is especially important yet challenging in the case of epithelial ovarian cancer (EOC), which contributes to the highest mortality among gynecological malignancies (8)(9)(10). ...
Synchronous bilateral ovarian cancer (SBOC) represents a relatively frequent occurrence and clinically relevant diagnostic dilemma. Delineation of its clonal architecture, genetic heterogeneity and evolutionary trajectories may have important implications for prognosis and management of patients with SBOC. Here we describe the results of next-generation whole-exome or whole-genome sequencing of specimens from 12 SBOC cases and report that bilateral tumors from each individual display a comparable number of genomic abnormalities and similar mutational signatures of single nucleotide variations. Clonality indices based on tumor-specific alterations supported monoclonal origins of SBOC. Each of the ovarian lesions was nevertheless oligoclonal, with inferred metastatic tumors harboring more subclones than their primary counterparts. The phylogenetic structure of SBOC indicated that most cancer cell dissemination occurred early, when the primary carcinoma was still relatively small (<100 million cells). Accordingly, the mutation spectra and mutational signatures of somatic variants exhibited pronounced spatiotemporal differences in each patient. Overall, these findings suggest that SBOC are clonally related and form through pelvic spread rather than independent multifocal oncogenesis. Metastatic dissemination is often an early event, with dynamic mutational processes leading to divergent evolution and intratumor and intertumor heterogeneity, ultimately contributing substantially to phenotypic plasticity and diverse clinical course in SBOC.
... According to various studies, 10% of women with ovarian cancer have SEOC and about 5% of women with endometrial cancer are diagnosed with SEOC [4][5][6][7]. The majority of women with SEOC are 41-54 years old, 40% of them are nulliparous, 2/3 of them are premenopausal, and 1/3 are obese [8]. ...
Synchronous ovarian and endometrial cancer (SEOC) is a rare instance but it accounts for 50–70% of all synchronous female genital tract tumors. We report three cases of women who were diagnosed with SEOC and underwent surgical staging. All cases were of the endometrioid subtype, grade 1, both in the ovarian and endometrial component. Two of them were stage Ia/Ia, and the third was stage Ib/Ib. More than 2 years after the diagnosis, all patients were alive and recurrence-free. The present report critically discusses the main characteristics, risk factors, and management of patients with SEOCs.
... Some authors believe "Field effect" may be responsible for synchronous tumours, the same mullerian origin of the uterine wall, fallopian tube and ovary make these organs behave as a morphological unit [8]. Other authors suggest that these neoplasms originate in metaplasia occurring in histologically similar epithelium of genital tract and peritoneum [9]. Estrogen may also be an important factor in the development of synchronous tumours [8]. ...
A 45-year-old, obese and premenopausal female presented with
abnormal uterine bleeding. On histopathological examination
and immunohistochemistry, synchronous serous carcinoma of
the endometrium and bilateral ovaries was diagnosed. There is
paucity of literature on the occurrence of synchronous serous
carcinoma of the endometrium and bilateral ovaries. It is important
to differentiate independent primary tumours from metastasis
because each carries a different prognosis and the clinical
management also differs.
... or metastasis to the ovaries [115][116][117][118]. The detection and differentiation between the two entities are critical for patient management and prognostication [117]. ...
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
... In this light, postoperative adjuvant treatment in patients with SPEOC should be individualized based on the risk of recurrence of each individual primary can- cer [3,5,610,11,13,15,19,22,41,42] . Furthermore, the application of postoperative adjuvant treatment of each primary cancer should not affect the postoperative adjuvant treatment of the other [1,3,5,6,[10][11][12][13]15,[19][20][21][22]24,[41][42][43][44][45][46]. To begin with, in patients with SPEOC the postoperative adjuvant radiotherapy remains the treatment of choice for the endometrial component and includes vaginal brachytherapy and external radiotherapy [6,10,11,13,[29][30][31][32][33]. ...
Synchronous primary cancers are very rare in the general population. Especially in malignancies of the female genital tract, only a small proportion between 0.5 and 1.7 % are synchronous primary cancers. Among them, synchronous primary endometrial and ovarian cancers (SPEOC) remains the most common combination.
Recent years, many international scientific societies (ACOG, FIGO and ESMO) have recommended systematic surgical staging as the initial treatment approach in patients with malignancies of the female genital tract. It is worth noting, that pelvic and para-aortic lymphadenectomy plays an essential role in the systematic surgical staging of patients with SPEOC.
Postoperative adjuvant treatment (radiotherapy and/or chemotherapy) plays an equally important role in patients with malignancies of the female genital tract and increased risk of recurrence or at advanced disease stage. Nevertheless, the efficacy of postoperative adjuvant treatment in patients with SPEOC, remains controversial.
... In this light, postoperative adjuvant treatment should be individualized based on the risk of recurrence of each individual primary cancer [3][4][5][6][7][8]37,38]. Additionally, the postoperative adjuvant treatment of each primary cancer should not affect the postoperative adjuvant treatment of the other neoplasm [3][4][5][6][7][8]10,13,[18][19][20][22][23][24]37,[39][40][41][42]. ...
... Synchronous endometrial and ovarian cancer is an uncommon event with the incidence ranging from 2% to 8.5%. 7 The incidence in our study was approximately 5.1% (47 in 915 patients). On the other hand, ovarian metastases have been reported to occur in approximately 5% of primary uterine cancers, 8 which is similar to our findings (5.2%, ...
Objective:
The purpose of this study was to evaluate the clinicopathological characteristics and survival outcomes of women with simultaneous endometrial and ovarian carcinomas having the same histopathologic type.
Materials and methods:
A review of medical records from 1997 to 2015 identified 72 patients with simultaneous carcinomas of the endometrium and ovary with the same histopathologic type. Patients with synchronous primary cancers of endometrium and ovary (SCEOs) were compared with patients with primary endometrial cancer with ovarian metastasis (ECOM). Clinical and pathological data were obtained from the patients' medical records. Clinicopathological variables including categorical data were analyzed by χ or Fisher exact test and continuous data by a Student t test. A Kaplan-Meier survival analysis was performed and compared by using the log-rank test.
Results:
A univariate and multivariate analysis of 72 patients with SCEO with the same histopathologic type revealed that SCEO is an independent prognostic factor of 10-year overall survival. There were 31 patients in the SCEO group and 41 patients in the ECOM group. With a mean follow-up time of 68.2 months, the 10-year overall survival rates were 61.3% and 36.6% in SCEO and ECOM groups, respectively (P = 0.029). Age, menopausal status, stage of ovarian cancer, performing lymphadenectomy, grade of endometrial tumor, omental metastasis, and residual tumor were found to be significant risk factors for recurrence in the synchronous group.
Conclusions:
The differentiation between SCEO and ECOM is of great clinical importance while our results showed a better prognosis for patients with SCEO compared with patients with ECOM. More aggressive therapeutic approaches may be considered for patients with SCEO who are older, postmenopausal, and/or have advanced grade of endometrial tumor, omental metastasis, and residual tumor. Lymphadenectomy should be performed in every patient with SCEO.
... Synchronous ovarian and cervical carcinomas have also been reported. The histology of these tumors is usually similar, with very few cases having different histology [2,3]. ...
... In the case of tumors with dissimilar histology, the diagnosis of two synchronous primary tumors is less in doubt. As shown by Castro et al. [3] following a literature review, tumors with dissimilar histology comprise 27.2% of cases of simultaneous carcinomas of endometrium and ovaries. The distinction between metastatic and independent tumors is signifi cant since it affects staging and prognosis [1]. ...
A case of a moderate differentiated endometrial carcinoma of the uterus with a synchronous poorly differentiated bladder cancer is reported. A review of the literature revealed that simultaneous presentation of primary endometrial and bladder neoplasm is rare and usually related to low-stage bladder lesions in contrast to our case with undifferentiated and the deep myometrial invasion of bladder lesion. A 79-year-old woman with endometrial cancer stage IB was performed of total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymph nodes dissection and adjuvant concurrent cisplatin-radiation therapy. After treatment, she complained intermittent gross hematuria. She was performed the bladder mucosal biopsy and finally diagnoses with poorly differentiated carcinoma of bladder. She received transurethral resection of bladder tumor alone without total cystectomy or any other adjuvant treatment due to her refusal. Her condition is tolerable except intermittent hematuria and anemia.
... Approximately 10% of women with ovarian cancer (OC) may have a synchronous endometrial cancer (EC), and 5% of women with EC may harbor a simultaneous OC [1][2][3]. ...
To estimate the incidence of synchronous endometrial cancer (EC) and ovarian cancer (OC) in the female population, among all women with EC, and in women under 50 years of age with EC, and to identify factors associated with synchronous EC/OC.
All cases of synchronous EC/OC and EC diagnosed in women residing in Olmsted County, Minnesota between 1/1/1945 and 12/31/2008 were identified. Incidence was estimated using the population denominator from decennial census data, corrected for hysterectomy prevalence. A case-control study using 15 identified cases (EC/OC) and 45 controls (EC alone) was performed.
The incidence of synchronous EC/OC and EC (age-adjusted to the 2000 US female total and corrected for hysterectomy prevalence) in 1945-2008 was 0.88 and 30.3 per 100,000 person-years, respectively. Among women under 50 years of age, the corrected incidence of EC/OC and EC was 0.51 and 5.1 per 100,000 person-years, respectively. Among all women with EC, 3.1% had a synchronous OC compared to 9.4% of women under 50 years of age with EC. Patients with synchronous EC/OC were more likely than those with EC alone to present with a pelvic mass (57.1% vs. 8.9%, p<0.001). Patients with EC alone were more likely to have used oral contraceptive pills (OCPs) than synchronous EC/OC cases (22.7% vs 0%; Odds ratio, 0.10; 95% CI, <0.01-0.87).
Although the incidence of synchronous EC/OC in the general population is lower than previously reported, nearly 1 in 10 women diagnosed with EC under 50 years of age will have a synchronous OC.
... Still there are no standard criteria for diagnosis and treatment of this kind of patients. Synchronous primary cancers of the endometrium and ovary occur in approximately 10% of all women with ovarian cancer and 5% of all women with endometrial cancer789. The present study demonstrated that the overall rate of coexisting adnexa malignance in endometrial cancer patients was 6.23%. ...
To explore and compare the differences in the clinicopathological characteristics and prognosis of synchronous primary endometrial and ovarian cancers with primary endometrial cancer metastatic to adnexa.
Between January 1997 and December 2009, 51 cases with endometrial cancer simultaneously with adnexa malignancy were identified. Among them, there were 18 cases with synchronous primary cancers of the endometrium and ovary (Group A) and 33 cases with primary endometrial cancer metastatic to the adnexa (Group B). Clinical and pathologic information was obtained from medical records. Parametric methods were used to compare clinical and pathologic features. Kaplan-Meier survival analysis was performed and compared using log-rank test.
The mean age at diagnosis of the disease was 56.6 ± 10.8 years (range 34-76 years) in Group A and 53.1 ± 9.5 years (range 37-76 years) in Group B. The two groups' distribution of preoperative image findings, size of endometrial lesion, myometrial invasion, unilateral or bilateral, cervix invasion, and postoperative radiation existed significant differences. With a mean follow-up time of 4.3 ± 3.4 years (range 2-11 years), 5-year overall survival (OS) was 75 and 56% in Groups A and B, respectively (p = 0.034). The univariate analysis showed only postoperative radiation and synchronous tumors were independent factors which affected OS (p = 0.015; p = 0.034) and progression-free survival (PFS) (p = 0.015; p = 0.036), respectively. Not any feature was revealed by multivariate analysis as independent prognostic factors.
Our results showed that OS and PFS of synchronous primary ovarian cancer in patients with endometrial cancer is better than those with ovarian metastasis patients. Pre- and intra-operative, intensive and careful assessment, and strict and continuous postoperative surveillance should pay attention to the endometrial cancer patients who preserved ovary for having possibility of coexisting occult ovarian lesions.
... Synchronous endometrial and ovarian cancer is uncommon event with the incidence ranging from 2-8.5 % (Castro et al., 2000). Presently, there was no consensus about the definite diagnostic criteria. ...
To determine the clinicopathologic variables and survival in the patients with synchronous endometrial and ovarian cancer (synchronous group) compared to the patients with primary endometrial cancer with ovarian metastasis (metastatic group).
The medical records of 423 endometrial cancer patients who received primary surgery were reviewed. Fourteen patients were diagnosed as synchronous group while 49 patients were diagnosed as metastatic group.
The median age in synchronous group was significantly younger than metastatic group (47 versus 56 years). More nulliparous and premenopausal patients were demonstrated in synchronous group. Synchronous group had significantly higher incidence of low grade tumor and lower incidence of deep myometrial invasion. All patients in synchronous group presented in stage I endometrial cancer. Moreover, most patients (85.7%) presented in early stage ovarian cancer and only 14.3% in advanced stage ovarian cancer. Synchronous group had better disease free survival (DFS) and overall survival (OS) than metastatic group. Estimated 5 years DFS was 64.2% versus 41.5%, (P = 0.17) and 5 years OS was 92.8% versus 48.5% (P = 0.036).
The patients in synchronous group were younger, more nulliparous and had a better prognosis than the patients in the metastatic group.
... During the last two decades, many epidemiologic and clinicopathologic data have shown that women with synchronous primary tumors of the endometrium and ovary represent a distinct subgroup of patients with early-stage and low-grade cancers in both organs and an overall prognosis surprisingly better than if their disease were classified as a single organ carcinoma with metastasis (2,5,9,28). Although the pathogenesis of these tumors is completely unknown, there are several lines of evidence which suggest that these tumors may share both the etiologic and histopathologic features of estrogen-dependent neoplasms of the endometrium (10,29,30). ...
The methylation status of hMLH1, CDKN2A, and MGMT was investigated in a panel of synchronous cancers of the ovary and endometrium, fulfilling the clinicopathologic criteria for independent primary tumors to define the possible role of epigenetic mechanisms in the development of these cancers.
Bisulfite-converted DNA from 31 tumors (13 endometrial and 18 ovarian carcinomas) and from matched normal tissue of 13 patients was analyzed by a methylation-specific PCR assay at the CpG-rich 5' regions of all three genes. In all tumors, we also investigated the presence of microsatellite instability and hMLH1 immunohistochemical expression in relation to hMLH1 hypermethylation status.
Methylation of hMLH1, CDKN2A, and MGMT was detected in 39%, 41%, and 48% of endometrial and ovarian tumors, respectively. hMLH1 hypermethylation was observed in all tumors of five patients, and it was invariably associated with loss of hMLH1 protein and presence of microsatellite instability. CDKN2A and MGMT methylation was randomly detected among both endometrial (45% and 24% of cases, respectively) and ovarian carcinomas (39% and 39% of cases, respectively). Concordant methylation at two or three genes was observed in 35% of cases.
Epigenetic inactivation of hMLH1, CDKN2A, and MGMT may be a common and early event in the development of synchronous primary endometrial and ovarian carcinomas and may qualify as a marker of a field cancerization encompassing the ovary and endometrium. Detection of MGMT hypermethylation may be useful to define a set of gynecologic malignancies with a specific sensitivity to alkylating chemotherapy.
Simultaneous detection of malignancy in the endometrium and ovary represents an uncommon event. The objective of the study was to clarify the possible factors that influenced on the survival. From 1977 to 2005, totally 27 patients fulfilled the criteria and were included in the study. The medical records and the pathologic reports were reviewed. The histologic determination was followed by the World Health Organization Committee classification, and cancer stage was based on the staging system of the FIGO. The Kaplan–Meier survival analyses were generated and compared by the log-rank test. The incidence of synchronous primary endometrial and ovarian cancers was 3.3% in patients with endometrial cancer and 2.7% in patients with ovarian cancer. The mean survival in the group of similar histology ( n = 15) was 63 months, and 48 months in the group of dissimilar histology ( n = 12) ( P = 0.63). The mean survival in the group of early stage ( n = 21) was 68 months and 15 months in the group of advanced stage ( n = 6) with statistic significance ( P = 0.0003). However, the impact of adjuvant therapy on survival did not reach statistic significance ( P = 0.15 for chemotherapy; P = 0.69 for radiotherapy). We conclude that the majority of the patients belonged to concordant endometrioid histology in endometrium and ovary, and it tends to be early stage and low grade with favorable prognosis. The stage had more significant influence on the survival than the histology. Adjuvant therapy should be given especially in patients with advanced stage although the optimal management remained to be determined.
A case of a mucinous adenocarcinoma of the ovary with a synchronous endometroid tumor of the endometrium with focal features of undifferentiated carcinoma and deep myometrial invasion is reported. A review of the literature revealed that our case is interesting in view of the fact that simultaneous presentation of primary ovarian and endometrial neoplasms is rare and usually related to low-stage ovarian lesions and well-differentiated and superficial endometrial carcinomas in contrast to our case with the focal features of undifferentiated carcinoma and the deep myometrial invasion. These double tumors usually present in premenopausal subfertile women with abnormal uterine bleeding. The prognosis in most of the cases is surprisingly good even after total abdominal hysterectomy and bilateral oophorectomy alone without adjuvant chemotherapy or irradiation.
Background:
Synchronous endometrial and ovarian cancer (SEOC) is a rare genital tract tumor. Precise diagnosis is crucial for the disease management since prognosis and overall survival differ substantially between metastatic endometrial cancer (EC) or OC. In this review we present 2 cases of women who were diagnosed with SEOC, and discuss the clinical characteristic of SEOC, diagnostic and molecular profiling issues. Next generation sequencing of 10 gene panel was performed on cancerous tissue and uterine lavage samples.
Case summary:
In our report patients with SEOC had endometroid type histology with early stage and low-grade histology for both EC and OC. They underwent surgical treatment and staging. Next-generation sequencing of 10 gene-panel identified CTNNB1, PIK3CA, and PTEN gene mutations in ovarian tissue in one case, while none of these genes were mutated in other case. Literature review in support to our data suggest a good prognosis for SEOC diagnosed at early stage.
Conclusion:
Accurate diagnosis of SEOC is essential for disease management and gene mutation analysis can be helpful as a complementary diagnostic and prognostic tool.
It is well recognized that some patients with endometrioid gynecological cancers have tumors arising in multiple sites (ovary, endometrium, and endometriosis) at the time of diagnosis. Molecular analysis has helped discern whether these multisite cancers represent synchronous primary tumors or alternatively metastatic disease. We present a complex case of a patient with endometrioid carcinomas arising in multiple sites. We discuss the use of mutation profiling to discern clonality and highlight how this information may inform the clinical management of such cases.
Objective
Vaginal hysterectomy with bilateral salpingo-oophorectomy may be an alternative strategy for patients with low-risk endometrial cancer and medical co-morbidities precluding laparoscopic or abdominal procedures. The current study evaluates the prevalence of co-existent ovarian malignancy in patients with endometrial cancer and the influence of bilateral salpingo-oophorectomy on survival outcomes in these patients.
Methods
Medline and EMBASE were searched for studies published between January 1, 2000 and November 20, 2017 that investigated (1) the prevalence of co-existing ovarian malignancy (either metastases or primary synchronous ovarian cancer in women with endometrial cancer, and (2) the influence of bilateral salpingo-oophorectomy on recurrence and/or survival rates.
Results
Of the pre-menopausal and post-menopausal patients (n=6059), 373 were identified with metastases and 106 were identified with primary synchronous ovarian cancer. Of the post-menopausal patients (n=6016), 362 were identified with metastases and 44 were identified with primary synchronous ovarian cancer. Survival outcomes did not differ for pre-menopausal patients with endometrial cancer with and without bilateral salpingo-oophorectomy (5-year overall survival rates were 89–94.5% and 86–97.8%, respectively).
Conclusion
Bilateral salpingo-oophorectomy during vaginal hysterectomy seems to have a limited impact on disease outcome in patients with endometrial cancer. These results support the view that vaginal hysterectomy alone or with bilateral salpingo-oophorectomy may be an option for patients with endometrial cancer who are not ideal surgical candidates.
Background:
Young women with endometrial cancer (EC) have an increased risk of synchronous ovarian cancer. The prognosis of women with synchronous endometrial and ovarian cancer (SEOC) is good. A high proportion of affected women have hereditary non-polyposis colon cancer syndrome (HNPCC).
Case presentation:
We present the case of a 45-year-old woman with histologically proven endometrioid adenocarcinoma of the endometrium (pT1B, G2, R0 without lymphovascular space invasion). She underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Final histology revealed a synchronous bilateral endometrioid ovarian cancer (pT1A, G2, R0). HNPCC analysis by immunohistochemistry showed no microsatellite instability in MSH2, MSH6, MLH1, and PMS2. No adjuvant therapy was administered, clinical follow-up with regular gynecological examinations was recommended. In a systematic literature review, 2,904 cases of women with SEOC were identified with 1,035 (36%) of them being premenopausal or <50 years of age. The proportion of women with SEOC among all reported EC cases was 842/23,498 (3%) and the proportion of young women with SEOC among all reported EC cases was 261/23,498 (1%). In summary, microsatellite instability and subsequent mutations in mismatch repair genes compatible with HNPCC were identified in 6/15 (40%) women analyzed. The mean recurrence-free and overall survival times of young women with SEOC were 1.9 (min 0.2, max 3) and 4.0 (min 0.2, max 22.1) years, respectively.
Conclusion:
Young women with EC have a high risk of synchronous ovarian cancer. Thus, in young women with EC, bilateral salpingo-oophorectomy or careful histological assessment of both ovaries are recommended in order to confirm or rule out SEOC. HNPCC testing should be offered to all women.
Hydrosalpinx in postmenopausal woman is rare. Most commonly it is due to primary ovarian malignancy with fallopian tube involvement
or primary fallopian tube carcinoma. But hydrosalpinx with no malignancy in the fallopian tube, associated with synchronous malignancy
of ovary and endometrium is rare. In a postmenopausal women, hydrosalpinx is commonly due to fallopian tube malignancy or rarely
pelvic inflammatory disease. We present a rare and very interesting case of 65-year-old nulliparous postmenopausal women with bilateral
hydrosalpinx and pyometra who was found to have papillary serous adenocarcinoma of the ovary and endometroid adenocarcinoma
of endomertrium with normal fallopian tube. One should always suspect genital malignancy with this presentation, especially in this age
group.
Endometrial cancer is generally a disease of postmenopausal women. However, in recent years, endometrial cancer in younger women is increasing because of lifestyle changes and diseases like diabetes mellitus, obesity, and polycystic ovarian disease. Ovarian preservation must be considered in this group of young premenopausal women. Traditionally, it was thought that metastases to ovaries or synchronous tumors were high, and therefore bilateral salpingo-oophorectomy was advocated. Several factors dictated this thinking, namely:
Objective:
Borderline ovarian tumors (BOTs) are treated surgically like malignant ovarian tumors with hysterectomy, salpingectomy, omentectomy, and multiple random peritoneal biopsies in addition to removal of the ovaries. It is, however, unknown how often removal of macroscopically normal-appearing tissues leads to the finding of microscopic disease. To evaluate the value of random biopsies, omentectomy, and hysterectomy in operations for BOT, the macroscopic and microscopic findings in a cohort of these patients were reviewed retrospectively.
Materials:
Women treated for BOT at Odense University Hospital from 2007 to 2011 were eligible for this study. Data were extracted from electronic records. Intraoperative assessment of tumor spread (macroscopic disease) and the microscopic evaluation of removed tissues were the main outcome measures.
Results:
The study included 75 patients, 59 (78.7%) in International Federation of Gynecology and Obstetrics stage I, 9 (12%) in stage II, and 7 (9.3%) in stage III. The histologic subtypes were serous (68%), mucinous (30.7%), and Brenner type (1.3%). Macroscopically radical surgery was performed in 62 patients (82.7%), and 46 (61.3%) received complete staging. The surgeon's identification of macroscopic tumor spread to the contralateral ovary and the peritoneum had a sensitivity of 88% and 69.2% and a specificity of 90.2% and 92.5%, respectively. The macroscopic assessment of the uterine surface, the omentum, and the pelvic and para-aortal lymph nodes was not a good predictor of microscopic disease. During follow-up, 4 patients (5.3%) relapsed with no relation to surgical radicality or the extent of staging procedures.
Conclusions:
Ovaries and peritoneal surfaces with a macroscopically normal appearance rarely contain a microscopic focus of BOT.
The purpose of this study was to determine the prognostic factors in women with synchronous endometrial and ovarian cancers.
Medical records of 3240 patients with endometrial cancer who had undergone primary surgery were collected from 7 institutions and were retrospectively reviewed. The progression-free survival (PFS) and overall survival (OS) curves and rates were calculated using the Kaplan-Meier method. Multivariate analysis to determine independent prognostic factors was performed using the Cox regression model.
The incidence of synchronous endometrial/ovarian cancer was 3.8% (123/3240 women). During the median follow-up period of 66 months, 33.3% and 26.1% of women developed recurrences and reported cancer-related deaths. The 5-year PFS and 5-year OS for all 123 women were 66.9% and 80.0%, respectively. In multivariate analysis, pretreatment CA-125 and tumor stage of the ovary showed prognostic significance about PFS (P = 0.043 and P = 0.027) and OS (P = 0.047 and P = 0.031), respectively.
Pretreatment CA-125 and tumor stage of the ovary were independent prognostic factors for recurrence and survival.
This study aimed to compare the prognosis of patients with synchronous endometrial and ovarian cancer (SEOC) to matched controls with either endometrial cancer (EC) or ovarian cancer (OC).
A retrospective case-control study including all patients with SEOC who had been treated at 5 European tertiary gynecologic oncology centers between 1996 and 2011 and patients with either EC or OC matched for age, International Federation of Gynecology and Obstetrics (FIGO) stage, histology, year of diagnosis, and Eastern Cooperative Oncology Group performance score.
The study cohort comprised 77, 132, and 126 patients with SEOC, EC, and OC, respectively. The patient characteristics confirmed an equal distribution of matching factors, and the median follow-up did not differ (P = 0.44). 48.1% of the patients with SEOC showed early FIGO stage I for both EC and OC. The 5-year PFS rates differed between SEOC and EC (76.3% vs 86.3%; P = 0.047) but not the 5-year overall survival rates (71.6% vs 79.8%; P = 0.12) and did not differ between SEOC and OC (76.3% vs 63.8%; P = 0.19 and 71.6% vs 69.3%; P = 0.61, respectively). After the adjustment for the FIGO stage of the 2 components of SEOC, neither PFS nor overall survival rates were different.
Prognosis of patients with SEOC tended to be the same in comparison with matched controls with either one EC or OC. Therefore, it could be considered that patients with SEOC may be eligible for clinical trials of the advanced tumor component if no additional therapy is indicated for the other component.
Abstract We report a case of uterine papillary serous carcinoma in a 50 years-old woman, after salpingo-oophorectomy performed for
ovarian cyst. Uterine papillary serous carcinoma metastases in ovarian mature teratoma was diagnosed by pathology examination.
Uterine primary neoplasm was suspected by magnetic resonance imaging and confirmed after uterine and cervix biopsy. Liver
and pleural metastasis with a fatal issue occurred after six weeks.
We report the case of a patient with synchronous neoplasms of the endometrium and ovary, which developed at a relatively young age (45 years). Clinical presentation consisted of hypermenorrhea. An ovarian tumor was subsequently detected through ultrasound and computed tomography. Pathological examination revealed endometrioid histology at both sites and, as in most synchronous tumors occurring in these locations, both the grade and the stage of the tumors were low. All these factors indicate a good prognosis.The association of these two tumors is relatively frequent in synchronous neoplasia in general. These neoplasms are low grade and have a good prognosis. Several current studies aim to establish clear criteria on how to differentiate two independent tumors from a single neoplasm affecting two distinct tissues by using sophisticated molecular biology techniques.
Ovarian cancer is the most lethal gynaecological malignancy, with epithelial tumours being the largest group (90%). Although most ovarian tumours create no histological diagnostic problems, a small proportion may be subject to misinterpretation resulting in serious clinical implications. The following are the most commonly encountered problems in surgical pathology practice: (1) deciding whether a malignant ovarian tumour is primary or secondary; (2) the problem of borderline epithelial tumours; (3) misinterpretation of some variants of endometrioid carcinoma; (4) realizing the existence of an admixture of epithelial patterns in a single tumour—e.g. serous plus endometrioid, endometrioid plus clear cell plus serous, etc.; and (5) distinguishing poorly differentiated carcinomas from non-epithelial undifferentiated tumours. In this review an attempt to address these problems is presented with some illustrative examples.
Objective
To investigate the clinical and pathological characteristics, treatment methods, and prognosis of synchronous primary cancer of the endometrium and ovary.
Methods
The clinical data of 43 patients with synchronous primary cancer of endometrium and ovary were retrospectively reviewed. The survival was calculated by Kaplan-Meier method and compared using the log-rank test.
Results
The median age of the patients at diagnosis was 49 years (range, 28–73 years). The most common symptoms were abnormal vaginal bleeding (69.8%) and abdominal or pelvic pain (44.2%). Pelvic masses were found in 39.5% of the patients and enlarged corpus in 27.9% at physic examination, while pelvic masses were found in 67.4% of the 43 patients (29 cases) and thickening or abnormal endometrium in 23.3% (10 cases) during ultrasound examination. Of 25 patients examined by CT/MRI, pelvic masses were found in 13 cases and enlarged uterus in 11 cases. All 15 patients who underwent endometrial biopsies were proven to have endometrioid carcinomas. Serum CA125 level was found to be elevated in 22 of the 34 examined cases (64.7%) with median value 500 U/mL (range, 39–3439 U/mL). FIGO stages of endometrial carcinomas: IA 18 cases, IB 20 cases, IC 2 cases, and IIA 3 cases; Stages of ovarian carcinomas: IA 19 case, IB 4 cases, IC 7 cases, II 4 cases, and IIIC 9 cases. Twenty-four patients (55.8%) were in stage I both endometrial and ovarian carcinomas. Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy, meanwhile, 12 patients had pelvic lymph nodes dissection. Thirty-eight of the 43 patients (88.4%) had a pathologically proven endometrial adenocarcinomas. The predominant ovarian histologies were endometrioid or mixed tumors with endometrioid components (30/43, 69.8%). Postoperatively, 26 patients (60.5%) received adjuvant chemotherapy alone, 12 had chemotherapy plus radiotherapy, only one patients had radiation alone and the remaining 4 cases received no adjuvant treatment. The 3-year and 5-year survival rates of the group were 87.4% and 71.1% respectively. The 3-year and 5-year survival rates of patients with endometrioid carcinoma at both endometrial and ovarian were higher than that of those with non-endometrioid or mixed histologic subtypes (93.8%, 82% vs 79.7%, 69%). The 3-year and 5-year survival rates of patients with early stages disease were better than those of other patients (93.3%, 93.3% vs 69.7%, 36.7%). Recurrence developed in 15 patients (34.9%). It was showed by univariate analysis that lower CA125 level, early FIGO stage, and adjuvant chemotherapy plus radiotherapy significantly and positively affected the 5-year survival rate, while only early FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors.
Conclusion
Synchronous primary cancers of the endometrium and ovary were different from either the primary endometrial or ovarian cancer, while usually it can be detected in early stage with a good prognosis. The impact of the CA125 level on prognosis needs to be further studied. Surgery treatment alone may be enough for early stage patients. Chemotherapy plus radiotherapy may be necessary for advanced patients.
The occurrence of double simultaneous primary cancers of the female reproductive tract is a common event. However, the occurrence of synchronous primary quadruple gynecologic malignancies is extremely rare. In this report, the clinical and pathological findings of a 35-year-old female patient with synchronous primary gynecologic cancers regarding papillary serous carcinoma of the left ovary, microinvasive carcinoma in situ of the left and right uterine tubes, endometrial intraepithelial carcinoma of the endometrium, and endocervical carcinoma in situ of the uterine cervix were presented. To our knowledge, the patient presented is the first case in aspect of accompanying ovarian papillary serous carcinoma to bilateral tubal microinvasive carcinoma in situ, endometrial intraepithelial carcinoma, and endocervical carcinoma in situ of the uterine cervix.
To investigate the clinical and pathological characteristics, treatment methods, and prognosis of synchronous primary cancers of the endometrium and ovary.
The clinical data of 43 patients with synchronous primary cancers of the endometrium and ovary were retrospectively reviewed. The survival was calculated by Kaplan-Meier method and compared using the log-rank test.
The median age at diagnosis was 49 years (range, 28-73 years). The most common symptoms were abnormal vaginal bleeding (69.8%) and abdominal or pelvic pain (44.2%).Pelvic masses were found in 39.5% of the patients and enlarged corpus in 27.9% at physical examination, while pelvic masses were found in 67.4% of the 43 patients (29 cases) and thickening or abnormal endometrium in 23.3% (10 cases) during ultrasound examination. Of 25 patients examined by CT/MRI, pelvic masses were found in 13 cases and enlarged uterus in 11 cases. All 15 patients who underwent endometrial biopsies were proven to have endometrial carcinomas. Serum CA125 level was found to be elevated in 22 of the 34 examined cases (64.7%) with a median value of 500 U/ml (range, 39-3439 U/ml). FIGO stages of endometrial carcinomas: IA 18 cases, IB 20 cases, IC 2 cases, IIA 3 cases; Stages of ovarian carcinomas: IA 19 cases, IB 4 cases, IC 7 cases, II 4 cases, III C 9 cases. Twenty-four patients (55.8%) were in stage I both endometrial and ovarian carcinomas. Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy, meanwhile, 12 patients had pelvic lymph node dissection. Thirty-eight of the 43 patients (88.4%) had a pathologically proven endometrial adenocarcinoma. The predominant ovarian histology was endometrioid or mixed tumor with endometrioid components (30/43, 69.8%). Postoperatively, 26 patients (60.5%) received adjuvant chemotherapy alone, 12 had chemotherapy plus radiotherapy, only one patient had radiation alone and the remaining 4 cases received no adjuvant treatment. The 3- and 5-year survival rates of the group were 87.4% and 71.1%, respectively. The 3- and 5-year survival rates of patients with both endometrioid and ovarian carcinomas were higher than that of those with non-endometrioid or mixed subtypes (93.8%, 82.0% vs. 79.7%, 69.0%). The 3-year and 5-year survival rates of patients with early stage disease were better than those of the other patients (93.3%, 93.3% vs. 69.7%, 36.7%). Recurrence developed in 15 patients (34.9%). It was showed by univariate analysis that lower CA125 level, early FIGO stage, and adjuvant chemotherapy plus radiotherapy significantly and positively affect the 5-year survival rates, while only early FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors.
Synchronous primary cancers of the endometrium and ovary are different from either primary endometrial carcinoma or ovarian cancer, while it can usually be detected in early stage and with a good prognosis. The impact of the CA125 level on prognosis needs to be further studied. Surgical treatment alone may be enough for early stage patients. Chemotherapy plus radiotherapy may be necessary for advanced stage patients.
To compare the survival and prognostic factors of patients with synchronous primary ovarian and endometrial cancers, and endometrial cancers metastatic to the ovaries.
Fifty-three patients with synchronous primary ovarian and endometrial cancer and 64 patients with endometrial cancer metastatic to the ovaries were evaluated.
Mean follow-up time was 47.2 months (18-170 months). There was no statistical difference in age, gravidity and parity between the two groups. Abnormal vaginal bleeding was the most common symptom in both groups. All patients were subjected to a surgical staging procedure. Overall survival of the synchronous group was significantly higher than that of the metastatic group (98 +/- 12 vs 59 +/- 6 months; p = 0.048). The significant prognostic factors for synchronous cancers after multivariate analysis were age, stage of ovarian cancer, grade of endometrial cancer, and adjuvant therapy status.
Patients with synchronous ovarian and endometrial cancers appear to have a good prognosis and should undergo primary surgical staging since the stage of tumors is a significant prognostic factor.
To determine the frequency of synchronous primary neoplasia of the ovaries in patients with primary malignant neoplasia of the uterus, and to analyze the clinical and histological characteristics of these cases.
Clinicopathological data from a series of patients treated for primary malignant neoplasia of the uterus between 1985 and November 2003 have been studied retrospectively.
Synchronous primary neoplasia of the ovaries was found in 13 out of 173 patients (7.5%) treated for primary malignant neoplasia of the uterus. In four patients (2.3%) the histological findings suggested ovarian metastases from primary endometrial adenocarcinoma. In four other cases (2.3%) there was extension of the primary uterine sarcoma to the ovaries. In the remaining five cases (2.9%) primary endometrial adenocarcinoma coexisted with: a) ovarian cystadenocarcinoma in two cases, b) ovarian fibromathecoma in two cases, and c) ovarian tumor of borderline malignancy in one case.
Coexistence of distinct primary neoplasias in the uterus and ovaries is rare. Diagnosis of two primary malignancies in the uterus and ovaries should be based on histological examination. Treatment should be appropriate for both tumors, taking into consideration that treatment of one tumor will not lead to subtreatment of the other.
To compare the survival and prognostic factors of patients with dual primary ovarian and endometrial cancers (primary group), and endometrial cancers metastatic to the ovaries (metastatic group).
Thirty-six patients with gross tumors confined to the pelvis and of endometrioid adenocarcinoma subtype in both the endometrium and ovary were selected from our file of 546 Japanese women with endometrial carcinoma. The patients were divided into two groups. Eleven were classified into the primary group. Twenty-five were classified into the metastatic group. Both univariate and multivariate regression analyses were carried out.
The mean age of the primary group was significantly younger than that of the metastatic group (45.2 years vs 51.2 years; P < 0.01). The cumulative 10-year survival of the primary group was significantly better than that of the metastatic group (90.9%vs 46.6%; P < 0.05). Univariate analyses showed that older age (P < 0.05) and the presence of lymphovascular space invasion (LVSI; P < 0.004) of the tumor of the uterus were significantly associated with a poor prognosis in the metastatic group. Multivariate analysis including the above variables showed no independent prognostic factor (older age, P < 0.60 and LVSI, P < 0.06).
When encountering women with coexisting endometrioid carcinoma in the endometrium and ovary with gross tumor limited to the pelvis, more attention should be paid to LVSI of the tumor of the uterus as a poor prognostic indicator.
A case of a mucinous adenocarcinoma of the ovary with a synchronous endometroid tumor of the endometrium with focal features of undifferentiated carcinoma and deep myometrial invasion is reported. A review of the literature revealed that our case is interesting in view of the fact that simultaneous presentation of primary ovarian and endometrial neoplasms is rare and usually related to low-stage ovarian lesions and well-differentiated and superficial endometrial carcinomas in contrast to our case with the focal features of undifferentiated carcinoma and the deep myometrial invasion. These double tumors usually present in premenopausal subfertile women with abnormal uterine bleeding. The prognosis in most of the cases is surprisingly good even after total abdominal hysterectomy and bilateral oophorectomy alone without adjuvant chemotherapy or irradiation.
Synchronous primary cancers of the endometrium and ovary are found in 5% of women with endometrial cancer and 10% of women with ovarian cancer. In the present case, a multigravid 46-year-old woman complained of lower abdominal pain and abdominal distension. She did not define abnormal uterine bleeding. Screening ultrasound revealed a papillary containing structure, irregular, cystic 16 x 15 x 10 cm right ovarian mass. Preoperative endometrial biopsy revealed endometrioid adenocarcinoma. Ascites sampling, radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, omentectomy, appendectomy and cytologic sampling of the undersurface of the diaphragm were carried out. Intraoperative and histological examinations showed Stage IIIC papillary serous carcinoma and stage IC endometrioid adenocarcinoma. Synchronous genital tract neoplasms constitute a more common clinical problem than would generally be expected.
The aim of this paper is to report a case of synchronous ovarian malignancy in a very young patient with early endometrial cancer who desired fertility-sparing management.
Twenty one-year-old patient presented with an apparent early stage endometrial cancer and desiring conservative management. After failure of conservative management for 3 years, surgery was performed. An incidentally small papillary serous ovarian tumor of low malignant potential was found.
Careful preoperative and intraoperative assessment of the adnexa is mandatory in young women with endometrial cancer. Those who desire ovarian preservation should be counseled regarding the high potential for coexisting ovarian malignancy.
Simultaneous detection of malignancy in the endometrium and ovary represents an uncommon event. The objective of the study was to clarify the possible factors that influenced on the survival. From 1977 to 2005, totally 27 patients fulfilled the criteria and were included in the study. The medical records and the pathologic reports were reviewed. The histologic determination was followed by the World Health Organization Committee classification, and cancer stage was based on the staging system of the FIGO. The Kaplan-Meier survival analyses were generated and compared by the log-rank test. The incidence of synchronous primary endometrial and ovarian cancers was 3.3% in patients with endometrial cancer and 2.7% in patients with ovarian cancer. The mean survival in the group of similar histology (n= 15) was 63 months, and 48 months in the group of dissimilar histology (n= 12) (P= 0.63). The mean survival in the group of early stage (n= 21) was 68 months and 15 months in the group of advanced stage (n= 6) with statistic significance (P= 0.0003). However, the impact of adjuvant therapy on survival did not reach statistic significance (P= 0.15 for chemotherapy; P= 0.69 for radiotherapy). We conclude that the majority of the patients belonged to concordant endometrioid histology in endometrium and ovary, and it tends to be early stage and low grade with favorable prognosis. The stage had more significant influence on the survival than the histology. Adjuvant therapy should be given especially in patients with advanced stage although the optimal management remained to be determined.
This study includes 29 patients with synchronous primary malignancies of the female genital tract. These patients constituted 1.7% of all genital malignancies. The most frequently observed synchronous neoplasms were those of the ovary together with the endometrium (51.7%). Most patients had early-stage and low-grade disease. Stage I disease was observed in 68.1% of patients with ovarian cancer. Patients with synchronous ovarian and endometrial cancer had a 73.3% 5-year survival rate, suggesting a favorable prognosis.
Twenty-nine patients had simultaneous malignant epithelial neoplasms of the uterine corpus and ovary. Three groups were defined on the basis of tumor histology: Group A: those with endometrioid carcinoma in both the uterus and ovary; Group B: those with special variants of corpus carcinoma (papillary, clear cell, mucinous) and identical neoplasms in the ovary; and Group C: those whose uterine and ovarian carcinomas were of dissimilar histologic types. Sixteen women had endometrioid carcinoma in both sites. The median age at diagnosis, 41 years, was younger than is usual for corpus or ovarian cancer. For all 16 patients, the grade of the ovarian endometrioid carcinoma was similar to that of the endometrioid carcinoma of the uterine corpus. Seven patients had bilateral ovarian neoplasms. Only one patient had myometrial invasion by the corpus carcinoma. No patient with simultaneous ovarian and uterine endometrioid carcinoma, regardless of grade, has died of cancer although one vaginal relapse was treated successfully. This excellent survival of patients with simultaneous endometrioid carcinomas is better than would be expected for either Stage III adenocarcinoma of the endometrium or Stage II ovarian carcinoma. These simultaneously occurring endometrioid neoplasms of ovary and endometrium are considered to be separate primary tumors. The morphologic reasons for this view and therapeutic implications are discussed.
A clinicopathologic study of 75 endometrioid carcinomas of the ovary was carried out. Thirty-six of the patients were in clinical Stages I and II and 39 in Stages III and IV. There were 49 histologically “pure” endometrioid carcinomas. the remaining 26 showed histologic admixtures of other neoplasms of Müllerian derivation. Thirty-six of the 75 cases were adenoacanthomas. By histologic grading, 45 were classified as Grades 1 and 2, 30 as Grades 3 and 4. Thirteen of the ovaries with carcinoma also harbored endometriosis. in 11 patients, there was a concomitant endometrial carcinoma. the 5- and 10-year survival figures for the entire series were 40.5% and 32.7%. Survival did not differ significantly between various subgroups or with different modalities of treatment and correlated best with clinical staging. Five-year survival was 92.5% in Stage I and 27.8%, 3.7%, and 0% in Stages II, III, and IV.
Eighteen carcinomas involving both the endometrium and the ovary were studied. Stage, size, bilaterality and pattern of ovarian involvement, histologic types and grades, presence of endometrial hyperplasia or ovarian endometriosis, myometrial, tubal, lymphatic and blood vessel invasion, and follow-up of the patients were all evaluated. Accordingly, the cases were classified as follows: Group A (nine cases), two separate primary tumors; and Group B (nine cases), uterine primaries with ovarian metastasis or ovarian primaries with uterine metastasis. Immunohistochemical stains (CAM 5.2, wide-spectrum keratin, vimentin, carcinoembryonic antigen (CEA), CA 12.5, CA 19.9) were performed in all cases. Flow cytometric determination of nuclear DNA was done in 13 (seven Group A and six Group B tumors). Of the nine cases with independent primary tumors, seven showed different immunohistochemical profiles in the ovarian and uterine tumors, whereas only four of the nine metastatic ones had similar staining characteristics. Five cases with independent primary tumors, but only one of the metastatic group, exhibited different aneuploid stemlines in the endometrial and ovarian tumors. The other seven (two independent and five metastatic) cases had similar DNA indexes in both tumors. Immunohistochemical and DNA flow cytometric study may be of some value for the distinction between metastatic and independent tumors, but differential diagnosis must presently rely largely upon conventional clinicopathologic criteria. 68:2455-2459, 1991.
In lifetesting, medical follow-up, and other fields the observation of the time of occurrence of the event of interest (called a death) may be prevented for some of the items of the sample by the previous occurrence of some other event (called a loss). Losses may be either accidental or controlled, the latter resulting from a decision to terminate certain observations. In either case it is usually assumed in this paper that the lifetime (age at death) is independent of the potential loss time; in practice this assumption deserves careful scrutiny. Despite the resulting incompleteness of the data, it is desired to estimate the proportion P(t) of items in the population whose lifetimes would exceed t (in the absence of such losses), without making any assumption about the form of the function P(t). The observation for each item of a suitable initial event, marking the beginning of its lifetime, is presupposed.
For random samples of size N the product-limit (PL) estimate can be defined as follows: List and label the N observed lifetimes (whether to death or loss) in order of increasing magnitude, so that one has Then , where r assumes those values for which and for which measures the time to death. This estimate is the distribution, unrestricted as to form, which maximizes the likelihood of the observations.
Other estimates that are discussed are the actuarial estimates (which are also products, but with the number of factors usually reduced by grouping); and reduced-sample (RS) estimates, which require that losses not be accidental, so that the limits of observation (potential loss times) are known even for those items whose deaths are observed. When no losses occur at ages less than t the estimate of P(t) in all cases reduces to the usual binomial estimate, namely, the observed proportion of survivors.
A material consisting of 23 endometrioid ovarian carcinomas, including 2 rare endometrioid tumors with argyrophil cells, was analyzed clinically and with the use of various histochemical staining methods. Electron microscopy was performed in 3 cases. Apical neutral mucin mixed with sulfate and carboxyl groups was typical for the cells at the light microscopic level, and a prominent Golgi complex with many small secretory vesicles was commonly seen at the ultrastructural level. The nuclei had concentric nuclear bodies and nucleoli with mesh-basket appearance. There was a positive correlation between the grade of differentiation and clinical stage. The corrected 5-year survival rate was 80% in stage I, 50% in stage II, 17% in stage III, and 0% in stage IV; the overall 5-year survival rate was 46%. Signs of increased endometrial estrogen activity were found in 6 of the 12 postmenopausal patients. In the whole series, 6 endometrial carcinomas were found simultaneously with the ovarian carcinoma.
Five cases of synchronous carcinomas of uterine endometrium and ovary are reported. All uterine cancers were typical endometrial adenocarcinomas. Among the ovarian cancers, four were serous papillary cystadenocarcinomas and one was an endometrioid carcinoma. There is much controversy with respect to staging and management of such cases since these tumors may represent either two synchronously occurring primaries or a single primary with metastases. It is suggested that when each tumor is confined within the limits of its tissue of origin the tumors may be considered as two separate primaries and surgery may be less aggressive. When there is evidence that at least one tumor is spreading to adjacent tissues and organs the question of two separate primaries or one metastatic tumor becomes academic only and aggressive surgical treatment with adjuvant chemotherapy is indicated.
A histopathologic review of synchronous primary neoplasms of the female reproductive tract is presented. During a 30-year period, 3863 patients with female genital malignancies were accessioned to the UCLA Tumor Registry: 958 had ovarian cancer, 776 endometrial cancer, 1556 cervical cancer, and 573 other gynecologic malignancies. Twenty-six (0.7%) patients with invasive synchronous primary cancers were identified. The most frequent synchronous genital lesions were ovarian and endometrial cancers in 11 patients (0.3%). No association was documented between genital and extragenital cancers. Patients with synchronous ovarian and endometrial cancers each were low stage and low grade, and the prognosis was excellent. Their detection in a relatively early stage suggests diagnosis may be facilitated by early symptoms from the endometrial carcinoma, and that these lesions are biologically of relatively low grade. These data support the conclusion that there is an association between low-stage epithelial carcinoma of the ovary and endometrial carcinoma.
Twenty-one of 34 simultaneous cancers involving the endometrium and ovary were classified as endometrial primary tumors with ovarian metastases. The criteria for this classification were either a multinodular ovarian pattern (major criterion) or two or more of the following minor criteria: small (less than 5 cm) ovary(ies), bilateral ovarian involvement, deep myometrial invasion, vascular invasion, and tubal lumen involvement. Twelve cancers were classified as independent neoplasms, primarily by the absence of the above criteria. Although they were classified as independent, the histologic features of the endometrial and ovarian tumors were the same in 11 of these 12 cases. Only one case represented an ovarian primary tumor with an endometrial metastasis. Both the group believed to have endometrial primaries with ovarian metastases and that with independent primaries showed high incidences of associated endometrial hyperplasia, supporting the belief that the endometrium is a primary site in both groups. The cancers classified as metastatic, with no known spread outside the endometrium-myometrium and ovary, were found to involve other sites significantly (P less than 0.01) more frequently than those classified as independent. Grade 3 endometrioid carcinoma, adenosquamous carcinoma, and malignant mixed müllerian tumors occurred only in the metastatic group, whereas the independent group had a variety of endometrioid and nonendometrioid tumors.
Ninety-four patients with borderline ovarian tumors were retrospectively analyzed for clinical features, treatments, and survival characteristics. There were 46 patients with FIGO stage IA cancer, 7 with stage IB, 20 with stage IC, 4 with stage IIB, 5 with stage IIC, 5 with stage IIIA, 3 with stage IIIB, and 4 with stage IIIC tumors. Seventy patients had at least a total abdominal hysterectomy and bilateral salpingo-oophorectomy, 20 patients had conservative surgery including unilateral salpingo-oophorectomy or ovarian cystectomy, and 4 patients had bilateral salpingo-oophorectomy. Fifteen patients with stage I disease received adjuvant melphalan therapy and 2 received external beam radiation for concomitant gynecologic cancers; 7 with stage II tumors received adjuvant melphalan therapy and 1 received external beam radiation; and 5 with stage III tumors received melphalan therapy and 6 patients received cisplatin-based combination chemotherapy. Follow-up ranged from 1 to 117 months, with a median of 33.5 months. Eighty-seven patients were alive. Seven patients died, two of disease. The overall 5-year survival rate was 83.0%; those treated with adjuvant therapy had a 79.5% survival, whereas the others had 84.6% survival. Second-look surgery was performed in 10 patients; six results were negative after melphalan therapy, one was negative after cisplatin combination therapy, and one was negative after no adjuvant treatment. Two patients had positive second-look surgery, one with stage IIIC disease treated with a cisplatin combination and the other with stage IC disease treated with melphalan. This review did not demonstrate that patients with borderline ovarian tumors benefited from adjuvant therapy.
The clinical stage assigned to simultaneously presenting carcinomas of the uterine corpus and ovary remains variable, depending on which of the two sites is considered to be the primary. Simultaneous involvement may occasionally represent independent primaries, a fact often overlooked. A review of all cases with a tissue diagnosis of carcinoma involving uterus and ovary was undertaken to identify those cases which possibly represent independent primaries. Seventeen such cases were identified on the basis of pathologic features, 15 of which revealed endometrioid type carcinoma at both sites. These 15 patients, who constitute the study group, were treated surgically with or without adjuvant therapy. Thirteen patients have been followed up for 1 to 12 years. Twelve patients are alive and free of disease. Vaginal vault recurrence occurred in a single patient. This was treated successfully. One patient died of an unrelated cause. The good survival fortifies the pathological impression that these cases represent independent primaries.
It is possible at times to observe derangements of homeostasis in the human being that may afford answers to unresolved metabolic or proliferative problems. Such is the case with certain functioning ovarian tumors. We have studied the endometrium from 115 patients with so-called feminizing ovarian tumors recorded in the Ovarian Tumor Registry and in our Institution to ascertain the endometrial response to more or less continuous endogenous estrogen stimulation. We noted cancer precursors in 43 per cent of this series and carcinoma in 21 per cent. Problems of selection and the possibility of other endocrinopathies prevent firm conclusions about the carcinogenic activity of estrogen in human beings.
The authors direct attention to a form of cancer being recognized with greater frequency today. The endometrioid carcinoma of the ovary has a prognosis different from the more usual cancers of the ovary.
Multiple primary neoplasms arising in the ovary and uterus were analyzed in 55 patients: 49 synchronous and 6, metachronous. When they occurred synchronously, 74.5% of the ovarian carcinomas and 93.6% of the uterine carcinomas were stage I lesions. The endometrial carcinomas were invariably well differentiated and superficial. It was the stage of the ovarian carcinomas that determined the prognosis of these patients. Ways of their identification as separate neoplasms are discussed. The potential to develop further neoplasms in the gastrointestinal tract and breasts should be borne in mind.
The 10-year experience at The Johns Hopkins Hospital with 61 cases of mixed Mullerian tumors were reviewed. The patients had a mean age of 63.7 years and the similar constitutional factors of diabetes mellitus, hypertension and nulliparity of endometrial adenocarcinoma. Only one patient had estrogen exposure. Eighteen percent had had prior exposure to pelvic radiation. The life table survival of the 61 patients was 41.1% at 5 years. The 2-year life table survival was 76% for disease confined to the uterus and 16.5% for extrauterine disease. There was no difference in survival between homologous and heterologous tumors. The surgical staging and the autopsies reviewed documented widely disseminated disease even when the tumor appeared to be confined to the uterus. It thus appears essential in order to improve survival these patients require aggressive staging and consideration of systemic adjuvant chemotherapy.
The coexistence of carcinoma in the endometrium and ovary is a relatively uncommon but not rare occurrence. In general it has not been possible to determine which, if any, of these tumors represent metastases from endometrium or ovary or separate primary neoplasms, and gynecologists are unable to agree upon appropriate therapy. Twenty-four women with synchronous carcinomas of the ovary and endometrium in whom disease was confined to the pelvis, diagnosed at the Milton S. Hershey Medical Center between 1970 and 1982, were identified. Thirteen women had typical endometrial adenocarcinoma and endometrioid carcinoma of the ovary (Group A), two had unusual variants of endometrial carcinoma and a similar appearing tumor in the ovary (Group B), and nine had typical endometrial adenocarcinoma with carcinomas in the ovary of differing histologic appearance (Group C). There was no significant difference in survival between women in Groups A and C (77 and 56%, respectively, mean follow-up approximately 40 months). However, deep myometrial invasion (outer third) provided a statistically significant indicator of poor prognosis (77% with deep invasion vs 17% with superficial invasion recurred or died of disease P less than 0.05, chi 2 test).
A case is reported in which there was a simultaneous occurrence of a well-differentiated papillary serous cystadenocarcinoma of the right ovary, a well-differentiated mucinous cystadenocarcinoma of the left ovary, and a rare, moderately differentiated papillary adenocarcinoma with psammoma bodies of the endometrium. A review of the literature failed to reveal the multiple simultaneous occurrence of this particular combination of malignancies of the female genital tract. The diagnosis, histology, and management are discussed. Histogenesis is discussed in relation to theory of area response, to an unknown factor, of embryologically related organs in the development of multiple, multifocal malignancies of the female reproductive system.
Twenty-nine patients had simultaneous malignant epithelial neoplasms of the uterine corpus and ovary. Three groups were defined on the basis of tumor histology: Group A: those with endometrioid carcinoma in both the uterus and ovary; Group B: those with special variants of corpus carcinoma (papillary, clear cell, mucinous) and identical neoplasms in the ovary; and Group C: those whose uterine and ovarian carcinomas were of dissimilar histologic types. Sixteen women had endometrioid carcinoma in both sites. The median age at diagnosis, 41 years, was younger than is usual for corpus or ovarian cancer. For all 16 patients, the grade of the ovarian endometrioid carcinoma was similar to that of the endometrioid carcinoma of the uterine corpus. Seven patients had bilateral ovarian neoplasms. Only one patient had myometrial invasion by the corpus carcinoma. No patient with simultaneous ovarian and uterine endometrioid carcinoma, regardless of grade, has died of cancer although one vaginal relapse was treated successfully. This excellent survival of patients with simultaneous endometrioid carcinomas is better than would be expected for either Stage III adenocarcinoma of the endometrium or Stage II ovarian carcinoma. These simultaneously occurring endometrioid neoplasms of ovary and endometrium are considered to be separate primary tumors. The morphologic reasons for this view and therapeutic implications are discussed. In contrast to the patients with endometrioid carcinoma, the eleven patients with other histologic types of carcinoma in the ovary and corpus were older (median age, 61 years) and more often postmenopausal (90%). These neoplasms were more aggressive, with frequent deep myometrial involvement (63%), tubal involvement (27%), and extension to other pelvic tissues (36%) at the time of initial diagnosis. Six of these 11 patients succumbed to their cancer despite surgical therapy and radiation. The distribution of tumor in some of these patients with nonendometrioid types of carcinoma is suggestive of a single primary with metastases. The therapeutic implications of these findings are discussed.
A cohort of 1192 patients with endometrial carcinoma were followed up to determine the frequency of other malignancies among them. The incidence rate of all types of cancer was not greater than in the general population. The relative risk of breast cancer after endometrial carcinoma was 1.3 times population rates. This increase, however, was confined to those who shared risk factors common to breast cancer--that is, nulliparity and, to a lesser extent, obesity. The parous, nonobese patient with endometrial carcinoma was not found to be at increased risk of subsequent breast cancer. An unusual occurrence of primary adenocarcinoma of the lung was found ten or more years after treatment for endometrial carcinoma. This increase was not associated with cigarette smoking.
A histological reevaluation was performed on 198 women with granulosa- and granulosa-theca-cell tumors treated at Radiumhemmet 1923–1972. Ninety-one percent of the patients were of clinical stage I (FIGO). The mean age at diagnosis was 52.6 years. All patients underwent surgery and all but 11% received complementary radiotherapy. Concomitant endometrial carcinoma was found in 6%. At the follow-up (1977–1978) 42 women had died from their granulosa-cell tumor. Advanced clinical stage, the presence of tumor rupture and pronounced nuclear atypia were associated with a poor prognosis. A high number of mitotic figures were of prognostic value only in stages II–IV. In stage I tumor size was related to outcome. The histological pattern of the granulosa-cell component was of no prognostic value.
The synchronous occurrence of carcinoma confined to the ovary and endometrium presents a diagnostic and therapeutic dilemma. These tumors have been variously staged as FIGO Stage IIA ovarian carcinoma, Stage III endometrial carcinoma, or synchronous dual primary carcinomas. Accumulating evidence suggests such patients have a favorable outcome. This retrospective study was undertaken to review our experience with these fascinating tumors.
The clinical records and the pathologic findings of 16 patients with synchronous dual primary ovarian and endometrial carcinomas were reviewed.
The median age was 51 years. Abnormal uterine bleeding was the most common presenting symptom (70%). All patients had Stage I ovarian and endometrial carcinomas. Fourteen patients (88%) had endometrioid carcinoma in both sites, while two patients (12%) had dissimilar histology. For 15 patients (94%), the grade of both tumors was identical. Only three (19%) patients had myometrial invasion, with less than 50% involvement in each case. All patients underwent surgical staging, 11 (70%) of whom received adjuvant radiation or chemotherapy. The five patients treated with surgery alone had Grade 1 endometrioid tumors. The only relapse occurred in a patient with a clear cell component in both sites. No patient has died of disease.
Patients with synchronous dual primary carcinomas appear to have a more favorable prognosis than that expected with Stage IIA ovarian or Stage III endometrial carcinoma (100% vs. 63% or 42% survival at 3 years, respectively). The excellent survival for patients with Grade 1 dual endometrioid tumors treated with surgery alone suggests that adjuvant therapy may not be necessary for this sub-group.
Synchronous carcinomas of the endometrium and ovary may indicate either independently developing neoplasms or metastatic disease. The clinical implications and prognosis of these two categories are quite different. The objectives of this study were to identify and evaluate the empirical criteria and significant therapeutic implications.
The National Taiwan University Hospital Cancer Registry records and pathological reports from 1977 to 1994 were reviewed. Empirical criteria were used to identify synchronous primary cancers.
A total of 322 patients had endometrial cancer and 421 patients had ovarian cancer in our Cancer Registry records. Eleven patients had simultaneous cancer involvement of both the endometrium and ovary. Six cases fulfilled the criteria of synchronous primary carcinomas of the endometrium and ovary. Of these, five were alive and free of disease for 35-144 months (median 94.2 months). The disease-free survival rates between patients with synchronous primary and metastatic cancers of different histologic types showed a statistically significant difference (P = 0.013). No statistical significance was noted for different histologic types (P > 0.5).
The empirical criteria used here were useful in identifying synchronous primary cancers of the endometrium and ovary. The favorable clinical outcome may relate to early detection of early-stage disease and low-grade malignancy with an indolent growth rate. Surgical management with or without adjuvant therapy has a satisfactory outcome in our experience.
To analyze a group of 22 patients with synchronous endometrioid tumors of the ovary and endometrium.
A retrospective chart review was undertaken and information collected on patient age, parity, tumor grade and stage, presence of coexisting endometriosis and survival. Flow cytometry was determined from archival samples of the endometrial and ovarian tumors.
The mean age at diagnosis was 52.8 years (range 36-71); mean parity was 1.05. With regard to the endometrial component, 68.2% were grade 1, 63.6% were stage I and, by flow cytometry, 62.5% were aneuploid. With regard to the ovarian lesions, 68.2% were grade 1, 68.2% were stage I, and 71.4% were aneuploid by flow cytometry. Twelve (54.5%) of 22 patients had pathologic evidence of coexisting endometriosis. Overall, three-year survival was 75%. All 11 patients with stage I disease at both sites were alive, without disease, at a mean follow-up of 34.9 months.
Patients with synchronous endometrioid tumors of the endometrium and ovary are generally younger than reported for either endometrial adenocarcinomas or ovarian epithelial adenocarcinomas. They tend to be low grade and early stage and are frequently associated with endometriosis. Our data suggest that the survival of patients with synchronous primaries correlates with the stage of the individual tumors and that a second, synchronous primary does not adversely affect prognosis.
The clinical characteristics and outcomes of endometrial cancer patients 45 years of age and younger were compared with those of patients older than 45 years of age.
We performed a cross-sectional study of 301 consecutive endometrial cancer patients referred to our center from 1989 to 1994. Of the 289 patients eligible for study, 40 were 45 years of age or younger (group A) and 249 were older than 45 years of age (group B).
The majority of patients in both groups presented with stage I disease. Of the women with stage I disease, patients in group A were more likely than those in group B to have low-grade disease localized to the endometrium (P < .001; relative prevalence 3.39; confidence interval [CI] 1.88, 6.12). However, the distribution of stages I to IV overall was the same for the two groups (P = .269). Although univariate analysis revealed that 11% of the patients in group A and 2% in group B had synchronous ovarian malignancies (P = .007; relative prevalence 5.42; CI 1.39, 21.14), multivariate logistic regression found that nulliparity, not age, was an independent risk factor for synchronous ovarian malignancy (P = .017; relative prevalence 6.15; CI 1.52, 25.61). There were no statistically significant differences by age in the prevalence of high-risk endometrial histology (serous and clear cell carcinoma) or in survival.
The overall distribution of tumor stage and survival were the same for the younger and older women; this finding contradicts previous reports that suggest that young women with endometrial cancer are at lower risk. Additionally, nulliparity, which occurs with a higher prevalence in younger women who develop endometrial cancer, is associated statistically with the development of synchronous ovarian malignancies.
A retrospective study was conducted to investigate the clinical significance of ovarian metastasis in 439 patients with clinical stage I endometrial cancer surgically treated by performing total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Histologic examination revealed that 22 patients (5%) had ovarian metastasis. The maximum diameter of the ovarian metastases ranged from 1 to 100 mm. In 18.2% (4/22) of patients with ovarian metastasis, the maximum diameter was less than 2 mm. Patients with metastasis limited to the ovarian surface showed 100% positive peritoneal cytology, 0% lymph node metastases, and 50% recurrence, while patients with metastasis inside the ovary showed 10% positive peritoneal cytology, 36% lymph node metastases, and 53% recurrence. The prognosis of patients with ovarian metastasis alone was situated midway between that of patients with cancer limited to the uterus and that of patients with lymph node metastasis alone. The lymph node status was of importance to determine the prognosis of patients with ovarian metastasis. The series also suggests that there may be two routes for ovarian metastasis; one is a route via the fallopian tube to the ovarian surface and the other is a route via the lymphatics to the inside of the ovary.
Our purpose was to review patients with granulosa and theca cell tumors as filed in the Emil Novak Ovarian Tumor Registry.
Our study was a descriptive, retrospective study of 454 case records.
The reviewed diagnoses were for 97 patients with granulosa cell tumors, 116 with theca cell tumors, and 97 with granulosa-theca cell tumors. The remaining cases (n = 144) were reclassified as "nonspecific" gonadal stromal tumors (n = 61), luteomas of pregnancy (n = 7), and 76 "other" cases. These included poorly differentiated cancer, metastatic cancer, mixed mesodermal tumors, and sarcomas. The tumor-related mortality rate for the 310 patients with granulosa, theca, and granulosa-theca cell tumors was 7% (37.3% for granulosa cell tumors only). The surgical stage of disease was the most significant prognostic factor, with a mortality rate of at least 40%, given that the tumor had spread beyond the ovary.
Because the differential diagnoses of particularly granulosa cell tumors included several conditions with an extremely poor prognosis, an accurate histologic diagnosis is crucial.
To evaluate the prognostic significance of and predictive factors for adnexal involvement (AI) in patients with endometrial carcinoma.
We retrospectively reviewed the pathological features and outcomes of endometrial carcinoma patients. The prognostic significance of AI was examined by univariate and multivariate analyses. Median follow-up was 30.7 months.
Of the 382 cases reviewed, 40 (10.5%) had AI. Patients with AI had a worse 5-year disease-free (DFS) survival (73.1 vs 37.1%, P < 0.0001) than patients without AI. However, patients with AI had multiple adverse features, including high grade disease, lymphovascular invasion, and additional sites of extrauterine disease. After controlling for these factors on multivariate analysis, AI lost its prognostic significance (P = 0.56). The 12 AI patients without other extrauterine disease had a favorable outcome (5-year DFS of 70.9%). Factors predictive of AI on logistic regression were metastatic disease, positive peritoneal washings, cervical involvement, and unfavorable histology.
Endometrial carcinoma patients with AI have relatively poor prognoses. However, AI per se has little, if any, independent prognostic significance. The poor outcomes seen in these patients appear to result from the preponderance of other adverse pathologic factors.
The traditional approach to patients with stage II endometrial carcinoma is preoperative radiation therapy (RT) followed by surgery. Currently, many patients are treated with primary surgery and postoperative RT. We retrospectively reviewed the outcome of 44 stage II (32 IIA, 12 IIB) patients who underwent surgery and postoperative RT. Nine (20%) had microscopic cervical involvement noted before surgery, and 35 (80%) had occult involvement noted postoperatively. Postoperative RT consisted of whole pelvic RT (WPRT) (50%), vaginal brachytherapy (VB) (18%), or both (32%). At a median follow-up of 40 months, the 5-year actuarial disease-free survival was 72.4%. Two patients (4%) had recurrence in the pelvis (one vagina, one lateral pelvis). Eighteen stage IIA patients treated with WPRT alone and eight stage IIA patients, without deep myometrial invasion (MI), were treated with VB alone, and remained controlled in the pelvis. Extrapelvic recurrences occurred in 12 patients (25%), primarily in those with deep MI and/or grade 2-3 disease. Our results suggest that patients with stage II endometrial carcinoma with microscopic or occult cervical involvement treated with surgery and postoperative RT have a favorable outcome. A high rate of pelvic control is achieved with RT tailored to the pathologic findings.
To determine the outcome, pattern(s) of failure, and optimal treatment volume in Stage IIIC endometrial carcinoma patients treated with surgery and postoperative radiation therapy (RT).
Between 1983 and 1998, 30 Stage IIIC endometrial carcinoma patients were treated with primary surgery and postoperative RT at the University of Chicago. All underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, sampling of pelvic lymph nodes (PLN), and peritoneal cytology. All were noted to have PLN involvement. Para-aortic lymph nodes (PALN) were sampled in 26 cases, and were positive in 14 cases (54%). Twenty women received whole-pelvic RT (WPRT) and 10 (WPRT), plus paraortic RT (extended-field RT, EFRT). One EFRT patient also underwent concomitant whole-abdominal RT (WART). Adjuvant vaginal brachytherapy (VB) was delivered in 10, chemotherapy in 5, and hormonal therapy in 7 patients.
At a median follow-up of 32 months, the actuarial 5-year disease-free and cause-specific survivals of the entire group were 33.9% and 55.8%, respectively. Overall, 16 women (53%) relapsed. Sites of failure included the pelvis (23%), abdomen (13%), PALN (13%), and distant (40%). Of the 7 pelvic failures, 4 were vaginal (3 vaginal only). Patients treated with VB had a trend to a lower vaginal recurrence rate (0/10 vs. 4/20, p = 0.12) than those not receiving VB. All 4 PALN failures were in women treated with WPRT (2 negative, 1 unsampled, and 1 positive PALN). None of the 10 EFRT patients (2 negative, 8 positive PALN) recurred in the PALN. No patient developed an isolated abdominal recurrence. Two patients developed significant RT sequelae: chronic diarrhea in 1 patient treated with WPRT and VB, and small bowel obstruction in 1 patient treated with EFRT.
FIGO Stage IIIC disease comprises a small percentage of endometrial carcinoma patients but carries a poor prognosis. Our failure pattern suggests that the optimal adjuvant RT volume is EFRT, even in women with negative PALN sampling. VB should also be administered to improve local control. The low rate of abdominal recurrence does not support the routine use of WART in these women. Given the predominance of failure in distant sites, attention should be focused on the development of systemic chemotherapy protocols.
Fifty cases of combined feminizing mesenchymomas of the ovary and carcinoma of the uterus were collected from the literature. The histories of 26 of these patients were critically examined. In a study of 66 feminizing mesenchymomas of the ovary in this laboratory, 4 cases of combined feminizing mesenchymomas and endometrial carcinoma were found. These 4 cases comprised 12 per cent of the postmenopausal group with feminizing tumors. The report of these cases brings the total number of recorded cases of combined tumors to 54. One case of combined granulosa-cell tumor and adenocarcinoma of the breast is also reported. Feminizing tumors of the ovary in combination with uterine carcinoma occur more frequently than is commonly realized. Various investigators have found that 15 to 27 per cent of postmenopausal women with feminizing tumors develop endometrial carcinoma. In the 54 cases of combined tumors, the thecoma occurred more often in combination with uterine carcinoma than did the granulosa-cell tumor, in spite of the much greater general incidence of the granulosal tumor. This suggests that the thecoma, by means of greater estrogen production, has the greater carcinogenic effect. It supports the concept that the thecal and not the granulosal cells are the sole or chief source of estrogen. The greatest carcinogenic response to tumor-produced estrogens occurs in the endometrium. Cervical and mammary carcinomas are seen only occasionally in combination with estrogen-producing tumors. The degree of carcinogenic response of these tissues to estrogens in postmenopausal life seems to parallel the degree of physiological response during menstrual life. A study of 26 case histories, still too few to be conclusive, indicates that, although feminizing tumors cause a greatly increased incidence of endometrial carcinoma, they do not seem to incite the appearance of this lesion at an age earlier than is noted in patients with endometrial carcinoma alone. Prolonged estrogen stimulation, rather than temporary intense estrogen stimulation, appears to be necessary for carcinogenesis. Several observations in these 26 cases support the concept that endometrial hyperplasia, in some predisposed postmenopausal women, occasionally is capable of transformation into carcinoma. Evidence is presented that, in the majority of cases of endometrial carcinoma, hyperestrogenism of varying degree is present. This hyperestrogenism seems to be the one added factor that sets off carcinogenesis in a postmenopausal woman already genetically predisposed to cancer. The cases of combined tumors are thought to represent the most extreme examples of this process. Therefore they offer an excellent opportunity for the study of the etiological role of estrogens in carcinoma of the endometrium. Clinical awareness, early preoperative diagnosis, and thorough endocrinological investigation of the combined tumors should throw additional light on this problem in coming years.
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