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Indian Journal of Pathology and Oncology 2022;9(4):347–349
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Indian Journal of Pathology and Oncology
Journal homepage: www.ijpo.co.in
Case Report
Synchronous endometrioid carcinoma of endometrium and ovary: A case report
V. Lavanya1,*, S Dhanalakshmi1
1Dept. of Pathology, K.A.P.V Government Medical College, Tiruchirappalli, Tamil Nadu, India
ARTICLE INFO
Article history:
Received 25-07-2022
Accepted 08-09-2022
Available online 14-12-2022
Keywords:
Synchronous endometrial ovarian
cancer
Endometrioid
Endometriosis
ABSTRACT
Objective: The synchronous endometrial and ovarian cancer is a rare phenomenon with incidence of 1.4
to 3.8%. Mostly in SEOC, the ovarian endometroid carcinoma arises in background of endometriosis with
endometrial carcinoma with lower stage and lower grade in premenopausal age group.
Case Report: Herein we present a case of 33year old female, presented with abdominal pain, underwent
TAH with BSO and histopathologically uterus and ovary showing features of Synchronous endometrial and
ovarian carcinoma of low grade with no nodal involvemnet in premenopausal lady.
Conclusion: The SEOC being a rare phenomenon with different therapeutic and favorable prognostic
considerations, when compared with metastatic carcinomas and hence SEOC can be managed with
multidisciplinary approach and regular follow up.
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1. Introduction
Primary synchronous cancers of the female genital tract
are relatively uncommon comprising 1-6% of all genital
neoplasms.1Amongst these, simultaneously detected
endometrial and ovarian malignancies constitute the
commonest occurrence (50–70% of all synchronous female
genital tract tumors). Due to the different management and
the favorable prognosis of SEOCs, it is important to separate
SEOCs from a metastatic disease.2
2. Case Presentation
A 33-year-old, nullipara, presented with complaints of
on and off spotting per vaginum, and intermittent dull
aching pain in lower abdomen for 1 year. She had no
history of weight loss, bladder or bowel complaints or any
hormonal pill intake. On examination, abdomen was soft.
Vaginal examination revealed a mass in the left adnexa.
* Corresponding author.
E-mail address:lavanvairam@gmail.com (V. Lavanya).
Abdominal USG and computed tomography abdomen and
pelvis showed multiloculated cystic lesion of size 8x5cm,
with solid components in left ovary, along with few
polypoidal lesions, heterogenous echoes in the uterine
fundus. Considering both ovarian and uterine mass, staging
laparotomy with bilateral pelvic lymphadenectomy and
peritoneal lavage was done.
Intraoperatively, uterus was of 6-8 weeks in size, there
was a lobulated solid cystic mass of 8x5cm arising from
left ovary. Right ovary and fallopian tube could not
be visualized. Peritoneal fluid cytology was negative for
malignant cells.
For histopathological examination we received uterus
with cervix with attached one side tube and ovary, uterus
with cervix measuring 12x9x6cm. Also, received mesentry
measuring 30cm in length. C/S of uterus - Endometrial
cavity dilated and showed a grey white polypoidal growth
measuring 3x2.7x2cm, extending into less than half of
myometrium and upto lower uterine segment. Also, received
ovary with attached fallopian tube, ovary measuring
8x5x3cm with attached tube measuring 4cm. E/S of ovary-
https://doi.org/10.18231/j.ijpo.2022.083
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348 Lavanya and Dhanalakshmi / Indian Journal of Pathology and Oncology 2022;9(4):347–349
lobulated. C/S shows a tumor with both solid and cystic
areas measuring 4x3.3x2cm. Remnant ovary measured
3x2x1cm. Grossly, tube showed no pathology.
Fig. 1: A): Uterus with endometrial polypoidal mass; B): Left
ovary showing grey white solid cystic areas
Sections studied from the polypoidal mass in
endometrium showed an infiltrating neoplasm arranged
predominantly as glands lined by columnar epithelial
cells exhibiting mild nuclear atypia, fine chromatin
and inconspicous nucleoli. Intervening stroma shows
inflammatory infiltrate and congested vessels. Tumor
infiltration is seen in less than half of myometrium. Section
studied from lower uterine segment showed invasion by
tumor. Sections studied from Ovarian mass showed ovarian
parenchyma with a neoplasm arranged predominantly as
glands lined by columnar epithelial cells, with reversal of
polarity and stratification. Nuclei exhibit mild atypia with
fine chromatin. Squamous morules made out in focal areas.
Intervening stroma showed inflammatory infiltrates and
congested vessels. Capsule appears intact. Left tube entirely
processed and showed no evidence of tumor.
There was a diagnostic dilemma, whether this is a
synchronous primary of both endometrium and ovary
or a metastatic disease. So we further proceeded with
immunohistochemistry. Vimentin was strongly positive in
endometrium and negative in ovary, whereas ER, PR was
positive in both tumors of endometriumand ovary. With
that we arrived at a conclusive diagnosis of Synchronous
Endometrioid carcinoma of endometrium and ovary. Both
of the tumors were low grade and of early stage with
invasion less than half of myometrium and tube free of
tumor added to the diagnosis of synchronous primary tumor
of endometrium and ovary. The patient received adjuvant
chemoradiation and is on followup.
3. Discussion
About, 10% of women with ovarian cancer have SEOC
and about 5% of women with endometrial cancer are
diagnosed with SEOC. The incidence of synchronous
endometrioid cancer of both ovaries and endometrium
is 1.4 to 3.8%.2This being a rare phenomenon with
different therapeutic and prognostic considerations, makes
it important to distinguish from the metastatic carcinoma.
Fig. 2: A.B): Shows an infiltrating tumor, mainly arranged in
glands lined by columnar cells with mild atypia; C): Back to
back arrangement of glands, suggestive of endometrial hyperplasia
foci; D): Ovarian Cyst wall with hemosedrin laden macrophages
suggestive of endometriosis; E): Ovarian parenchyma with tumor
arranged in glands; F): Mild nuclear atypia with reversal of
polarity
Fig. 3: A): ER positive in endometrial tumor; B): Vimentin
positive in endometrial tumor; C): ER positive in ovarian tumor;
D): Vimentin negative in ovarian tumor
Lavanya and Dhanalakshmi / Indian Journal of Pathology and Oncology 2022;9(4):347–349 349
The most common presentation of age group are 41-
54 years, 40% of women are nulliparous, about 75%
are premenopausal.3The most common presentation of
SEOC is abnormal uterine bleeding with pelvic pain or a
palpable pelvic mass. Our patient is a nulliparous women,
presented with lower abdominal pain. Endometrial cancer
with synchronous ovarian cancer is usually superficial
and well differentiated, stage I-II disease. In most cases
the ovarian endometroid carcinoma arises in background
of endometriosis with endometrial carcinoma with lower
stage and lower grade.4The pathogenesis of SEOC is
considered that embryologically similar tissues are affected
from hormonal stimulation and other carcinogenic factors in
female genital tract. The hypothesis of “microenvironment
restriction” reflects the low potential of metastasis of
SEOC.4Pretreatment concentration of CA-125 and the
tumor stage of the ovary are independent factors in SEOCs.
Immunohistochemistry and DNA flow cytometry helps in
differentiation between primary and metastatic tumors.5
By analyzing mitochondrial DNA and sequencing different
genes, a clonality of SEOCs was confirmed. Nuclear
localization of β-catenin, presence of CTNNB1 mutations
and DNA mismatch repair protein (MMR) are associated
with SEOC.6
Ulbright T and Roth L devised the pathological criteria
for synchronous gynecological tumors which includes,
1. Both the tumors must have a different
histopathological origin, or
2. Must fulfil all the minor criteria as follows: tumors
must be restricted, no distant metastasis, no connection
between the tumors, no lymphovascular tumor emboli,
and no myometrial invasion).4
Synchronous tumors can be classified into three groups: (by
Scully et al.)
1. Endometrial cancer with metastasis to the adnexa.
2. Ovarian cancer with metastasis to the endometrium.
3. Synchronous primary tumors.
Pathological criteria described by Scully et al.
1. Histological dissimilarity of tumors;
2. No or only superficial myometrial invasion of
endometrial tumor;
3. No vascular space invasion of endometrial tumor;
4. Atypical endometrial hyperplasia additionally present;
5. Absence of other evidence of spread of endometrial
tumor;
6. Ovarian tumor (80-90% of cases),
7. Ovarian tumors located mainly in parenchyma;
8. No vascular space invasion, surface implants, or
predominant hilar location in the ovary;
9. Absence of other evidence of spread of ovarian tumor;
10. Ovary endometriosis present.6
4. Conclusion
The differentiation of synchronous and metastatic tumors
is important as it affects tumor staging and prognosis.6A
multidisciplinary and patient-oriented approach helps in the
management and increase in life expectancy of the patient
in synchronous primary malignant tumors.3
5. Source of Funding
None.
6. Conflict of Interest
None.
References
1. Goldblum J, Lamps L, Mckenney J, Myers J. Rosai and Ackerman’s
Surgical Pathology. United Kingdom: Elsevier; 2018.
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3. Gungor T, Kanat-Pektas M, Ustunyurt E, Mollamahmutoglu L.
Synchronous primary tumors of the female genital tract: A single center
experience. Arch Gynecol Obstet. 2009;279(5):667–72.
4. Ulbright TM, Roth LM. Metastatic and independent cancers of the
endometrium and ovary: A clinicopathologic study of 34 cases. Hum
Pathol. 1985;16(1):28–34.
5. Oranratanaphan S, Manchana T, Sirisabya N. Clinicopathologic
variables and survival comparison of patients with synchronous
endometrial and ovarian cancers versus primary endometrial cancer
with ovarian metastasis. Asian Pac J Cancer Prev. 2008;9(3):403–7.
6. Lim YK, Padma R, Foo L, Chia YN, Yam P, Chia J, et al. Survival
outcome of women with synchronous cancers of endometrium and
ovary: a 10 year retrospective cohort study. J Gynecol Oncol.
2011;22(4):239–43.
Author biography
V. Lavanya, Post Graduate
S Dhanalakshmi, Associate Professor
Cite this article: Lavanya V, Dhanalakshmi S. Synchronous
endometrioid carcinoma of endometrium and ovary: A case report.
Indian J Pathol Oncol 2022;9(4):347-349.
