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[Synchronous primary cancer of the endometrium and ovary]
Abstract
Unlabelled:
To investigate the clinical and pathological characteristics, treatment, and The data of 12 patients prognosis of synchronous primary cancer of the endometrium and ovary. Methods with synchronous primary cancer of the endometrium and ovary were retrospectively reviewed . Results Eight patients had the same histological type of endometrioid carcinoma in both uterus and ovary, 4 patients had different histological types in uterus and ovary. Synchronous primary cancer of the endometrium and ovary was difficult to be dignosed preoperatively. All ovarian tumors were small with an average diameter of 7 cm. Infertility was common among these patients(40.7%). Most of them had early stage I lesion (66.7%). endometrioid carcinomas was the main pathologic type (66.7%). All patients were treated surgically followed by chemotherapy with a 3-year survival rate of 66.7% (8/12).
Conclusion:
Synchronous primary endometrium and ovary cancer is a specific kind of tumor different from either the primary endometrium carcinoma or ovary carcinoma, and usually can be detected in early stage with a good prognosis.
... The accurate diagnosis of synchronous primary gynecological tumors is important because a diagnosis of synchronous cancer would affect the treatment (Chiang et al., 2008). Independent primary tumors of the endometrium and ovary were stated as the most commonly encountered synchronous tumors of the female genital tractus, occurring in approximately 10% of all women with ovarian tumors and 5% of all women with endometrial tumors by the plenty of studies (Soliman et al., 2004; Lou et al., 2006; Zaino et al., 2001). In this study we aimed to evaluate the frequency and types of synchronous gynecologic cancers in Turkish 1 ...
... The most frequent cancer type was the endometrioid adenocarcinoma (66/110, 60%). In our study, the median age at diagnosis of women with synchronous endometrial and ovarian cancer was 52.6 (33-76) years in contrast, women who develop endometrial or ovarian cancer alone are predominantly postmenopausal, the median diagnosis age was between 60–63 years (Soliman et al., 2004; Lou et al., 2006; Zaino et al. 2001,Young et al. 2002, Brown et al. 2001). Other studies also reported that, patients having synchronous cancers were younger than their counterparts (Williams et al., 2009). ...
... We found 1.0% (43/4185) of the gynecological cancers were synchronous ovarian and endometrial cancers. Some studies reported 10% of the ovarian cancer patients had endometrial cancer also (Soliman et al. 2004, Lou et al. 2006, Zaino et al. 2001). ...
To evaluate the synchronous gynecologic cancers in Turkish women.
A population-based longitudinal cohort study was conducted using Izmir Cancer Registry (ICR) data on gynecologic cancer patients diagnosed in the period 1993 to 2005. The registry covers the 3.7 million population of Izmir and has been collecting data on cancer incidence and survival of cancer patients' since 1992. The ICR collects data on all new cases of cancer from all the hospitals (n = 22) in the city.
A total of 4,185 women were identified with gynecologic cancer between 1993 and 2005, 1,526 with endometrial, 1,206 with cervical, 1,198 with ovarian, 115 with vulvar, 67 with other uterine ( sarcoma etc.), 33 with vaginal and 40 with other gynecologic cancers ( tuba uterina etc.). Fifty-five (1.3%) patients with invasive synchronous primary cancers were identified, 43 of these tumor pairs being endometrium-ovaries (81%), 66 of all lesions being endometrioid adenocarcinomas.
Independent primary tumors of the endometrium and ovary are the most commonly encountered synchronous tumors of the female genital tractus with endometrioid adenocarcinoma as the most frequent component.
... El índice de masa corporal promedio en este tipo de mujeres es de 28 kg/m 2 y un tercio de las pacientes son obesas. Dos tercios de estas con tumores sincrónicos son premenopáusicas y cerca del 40% son nulíparas (16,17). ...
... Las manifestaciones clínicas de esta entidad son inespecíficas, muchas de ellas se presentan como síndromes constitucionales, caracterizados por anorexia, astenia, adinamia y pérdida de peso. La hemorragia uterina anormal es el hallazgo más común; en estas mujeres el 69% presentan cáncer ovárico estadio I (7,12,17). ...
El desarrollo sincrónico de múltiples tumores en el tracto genital femenino es muy infrecuente, presentándose tan solo en el 1 al 2% de los cánceres ginecológicos. De estos, el 50 al 70% lo constituyen el grupo de neoplasias primarias sincrónicas de endometrio y ovario. El objetivo del artículo es exponer un caso diagnosticado histopatológicamente en el Departamento de Patología de la Universidad Industrial de Santander en material procedente de histerectomía abdominal ampliada, salpingooforectomía bilateral, linfadenecto-mía pélvica y apendicectomía, y hacer una revisión de la literatura de esta entidad, dada la infrecuencia de su diagnóstico y a la escasa información local al respecto.
... They may occur at the same site or at different sites and, may have the same or different morphologies. Independent primary tumours of the endometrium and ovary are the most common synchronous tumours of the female genital tract, occurring in 10% of all women with ovarian tumours and 5% of all women with endometrial tumours [2][3][4]. ...
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.
Antecedentes:
existe una asociación demostrada entre endometriosis y algunas histologías del carcinoma epitelial de ovario. Por otra parte, se ha observado que hasta un 30% de las neoplasias de ovario se presentan de forma concomitante a neoplasias del endometrio. Para considerar la sincronicidad entre estos tumores, estos deben cumplir criterios anatomopatológicos estrictos como los descritos por scully.
Objetivo:
presentar un caso clínico de carcinoma endometrioide sincrónico de ovario y endometrio sobre focos de endometriosis, así como su diagnóstico y manejo.
Caso clínico:
paciente de 27 años que consulta por spotting intermenstrual. En la ecografía endocavitaria se observa un pólipo endometrial. Además, se describe un tumor anexial izquierdo de 42mm, trilobulado, con un polo sólido de 17×15mm. Se somete a una polipectomía histeroscópica y quistectomía ovárica laparoscópica. Asimismo, se reseca implante sospechoso en el fondo de saco posterior. El resultado anatomopatológico de las piezas quirúrgicas fue: pólipo endometrial con hiperplasia compleja con atipias y focos de adenocarcinoma endometrioide grado I; el tumor quístico ovárico izquierdo consistente con quiste endometriósico con focos de adenocarcinoma endometrioide. La lesión peritoneal corresponde a un implante de adenocarcinoma endometrioide grado I.
El estudio de las características anatomopatológicas y la presencia del implante peritoneal sugieren el diagnóstico de un carcinoma endometrioide ovárico con origen en una lesión endometriósica sincrónico con un carcinoma endometrioide endometrial.
Conclusión:
el diagnóstico diferencial entre la sincronicidad o diseminación de los tumores de ovario y endometrio de estirpe endometrioide supone un reto para el clínico y es fundamental para el correcto manejo de estas neoplasias.
Metastases to the ovary, particularly when mucinous, are treacherously difficult to distinguish from primary ovarian neoplasms. In routine clinical practice, this remains among the commonest and worst misdiagnoses in gynecological pathology and one that pathologists and clinicians alike can easily make. The error can have especially dire clinical consequences when metastasis from a silent extraovarian primary presents as an apparent low-stage ovarian carcinoma, but can equally be made, to the detriment of management, in an ovarian neoplasm with a known other primary.
Over the last three decades or so, a volume of literature has appeared emphasizing the features of primary and metastatic ovarian tumors for correct distinction. There are many general clinical, gross, and histological features that are helpful, apart from features specific to metastases from particular types and sites of primary tumor. Metastatic tumors tend to be bilateral, relatively small in size, and show surface involvement and vascular invasion, though exceptions occur. Some histological patterns, such as signet ring carcinoma, colloid carcinoma, and tumors associated with pseudomyxoma peritonei, are essentially exclusive to metastases. Specific tumor types are discussed individually in the chapter.
The vast majority of cases can be accurately diagnosed with due attention to morphological features, with or without the help of immunohistochemistry, and it is only a tiny minority whose true nature may not become apparent till after a period of clinical follow-up.
Synchronous development of multiple tumors in the female genital tract is rare, occurring only in the 1 to 2% of gynecologic cancers. Of these, 50 to 70% consists of the group of synchronous primary neoplasms of the endometrium and ovary. The aim of this paper is to present a case diagnosed histopathologically at the Department of Pathology of the Universidad Industrial de Santander in a sample for histological study consists of material from enlarged abdominal hysterectomy, bilateral salpingoophorectomy, pelvic lymphadenectomy and appendectomy sent by the Hospital Universitario de Santander in 2010, and a review of the literature of this entity, given the rarity of its diagnosis and the lack of local information about it.
Cancer is the second most common cause of death among women who are in reproductive ages; however it is not common during pregnancy. There are few numbers of documents concerning cancer and its related treatment outcomes and prognosis during pregnancy. The aim of this study was to review our experience about gestational cancer. In this retrospective chart review study, 25 pregnant women with any kind of diagnosed malignancy who attended hospitals in Uremia and Sanandaj city since 10 years ago were assessed. Cancer cases were verified by a pathologist using pathology and TNM system for tumors staging. Then survival duration was analyzed using Kaplan-Maier plot. From all, 10 women had gynecologic cancers and 15 had non-gynecologic cancers. Ovarian cancer was the most common malignancy. The mean of survival was 67 months for all patients (CI95%: 23.7-110.3), 67 months for gynecologic cancer group (CI95%: 40.2-93.8) and 69 months for non-gynecologic cancer group (CI95%: 0-159) (p = 0.51). According to the results, the cancer complaints and symptoms must be examined thoroughly and do not take them as pregnancy complications since delays in prognosis leads to more severe problems and makes treatment difficult. If cancer is treated carefully after three months of gestation, probably it won't have severe side effects for fetus.
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.
About 1-2% of women with gynaecological cancers are found to have two or more simultaneous independent primary malignancies. Low stage multiple primaries must be distinguished from metastasis from one to other site for correct management. Synchronous tumours in the ovary and endometrium are the commonest combination. Most of these can be accurately categorised by standard histological criteria. Molecular testing has been advocated for valuable adjunctive information in ambiguous cases but must be interpreted with clinicopathological correlation: loss of heterozygosity, pTEN or beta-catenin gene mutational analysis, microsatellite instability and most recently gene expression profiling have all been used. The pattern of beta-catenin immunohistochemical expression has been reported to be of value. A very low percentage of women with synchronous primaries in the uterus and ovary are HNPCC patients and testing for mismatch repair gene mutations is unnecessary in all cases, even if young; the diagnosis of HNPCC should be based on standard criteria. Women with endometrial cancer under 50 are more likely than older patients to have a synchronous ovarian cancer. Rarer combinations of synchronous tumours are less well studied but may also represent a mixture of unusual patterns of metastasis and multifocal origin; these are discussed briefly.
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