A case of synchronous serous ovarian cancer and uterine serous endometrial intraepithelial carcinoma

Abstract

Background Serous endometrial intraepithelial carcinoma (SEIC) is now considered to represent an early stage of uterine serous carcinoma (USC). It is an intraepithelial lesion but has been reported to cause extrauterine metastases. We report a case of SEIC with serous ovarian carcinoma and lymph node metastasis. Case presentation A 57-year-old post-menopausal woman (gravida 3, para 2, SA1) was referred to our hospital with lower abdominal pain. An ultrasound and MRI showed that the ovary had swollen to 8 cm in size and had a solid lesion. The uterus was normal. The patient underwent exploratory laparoscopy on the suspicion of torsion of the ovarian tumor. Intraoperative findings showed a right ovarian tumor, but no ovarian tumor torsion was observed. A small amount of bloody ascites was found in the Douglas fossa, and bleeding was observed from the tumor itself. A right salpingo-oophorectomy was then performed. Histopathological results revealed a high-grade serous carcinoma. Forty days after the first surgery, we performed a staging laparotomy: a total abdominal hysterectomy, left salpingo-oophorectomy, systematic pelvic and paraaortic lymphadenectomy, and a partial omentectomy. A complete cytoreduction was achieved. In the pathological examination, the invasion of the serous carcinoma was observed in the left ovarian ligament, and lymph node metastasis was found in the paraaortic lymph nodes. Atypical columnar cells formed irregular papillary lesions which had proliferated in the endometrium, and this was diagnosed as SEIC. The final diagnosis was serous ovarian cancer, FIGO stage IIIA1(ii), pT2bN1M0, with SEIC. Conclusion We report a case of SEIC with synchronous serous carcinoma of the adnexa uteri. Both were serous carcinomas and, thus, it was difficult to identify the primary lesion. The distinction between metastatic cancer and two independent primary tumors is important for an accurate diagnosis and tumor staging. Histological diagnostic criteria remain controversial, and further development of a method for differentiating between both diseases is required.

Critical Overview of Serous Endometrial Intraepithelial Cancer Treatment: Systematic Review of Adjuvant Options

“…In 46 of 81 patients, there was no evidence of disease at the end of follow-up, 12 patients were alive with the disease, 18 patients died from the disease and 2 patients died from other causes. In two studies, 62.5% and 33.3% of patients receiving adjuvant chemotherapy, respectively, relapsed [2,10], while, in three studies, none of the patients relapsed [3,12,14]. Among patients not receiving any adjuvant treatment, only in one study were no relapses reported [13], and the average recurrence rate was 28.78%, ranging from 16.6% to 100%, and the DFS was 59.1%.…”

“…Two studies have described simultaneous SEIC and ovarian carcinoma. It was impossible to determine whether these were two independent neoplasms or if the SEIC had developed previously [2,14]. Serous endometrial and ovarian tumors may have similar characteristics under the microscope and may be difficult to distinguish because of their structure alone.…”

The comparison of pure uterine serous carcinoma and mixed tumor with serous component: a single-institution review of 91 cases

“…Our study observed SEIC in both pure and mixed USC groups (20% vs. 6.9%), with up to 67% of SEIC patients having extrauterine disease, indicating the aggressive biological behavior of USC and SEIC. As a p53-driven neoplasm, p53 abnormalities exist even in SEIC lesions [ 16 ]. Our study showed that the TP53 mutation rate of p-USC and m-USC groups was 89.3% and 87.1%, respectively.…”

Synchronous borderline ovarian tumor with endometrioid endometrial carcinoma - from diagnosis to treatment. A Case study

“…It is a major clinical problem for gynecologists, as its diagnosis is very complicated and is based primarily on histopathological criteria [9,10,2]. It is important to distinguish between double primary cancer, or synchronous cancer, and metastatic disease as this helps establish an accurate diagnosis and assess the grade of the tumor and is also essential in selecting optimal follow-up treatment and predicting the patient's prognosis [11,12].…”