DR T.ALLAMEH

DR E.GHOLAMIAN

A32 Y female /virgin with 1 year AUB

She had been menarc since 14 Y/O.

She had been hypo menorhea and then She had been hypo menorhea and then oligomenorhic.

From 1.5 years ago she had been menometrorrhagia & hypermenorrhea.

She was visited with gynecologist 14 months ago and requested for her laboratory and sonography.

SonograficSonografic finding is:finding is:

UT=102*45 mm

ET=17 mm with hypo echoic leison ET=17 mm with hypo echoic leison

LT ovary contain cyst 118*91mm (multi cystic & solid cystic with thick septa)

RT ovary is 31*20 mm

No ascitis

Laboratory finding is:Laboratory finding is:

LDH=256 LDH=256

BHCG=<0.5

CA125=198.3

MRI finding is:MRI finding is:

A large about 10-12 cm complex multiseptated cystic mass lesion with solid multiseptated cystic mass lesion with solid component occupying pelvic cavity associated with some ascites.

Endometrial cavity is also markedly enlarged measuring about 16 mm in largest diameter.

Fractional curettage & vaginal specimen:

Endometrioid endometrial adenocarcinoma

Touch Imprint x100 Touch Imprint x400

Frozen Section of the Vaginal Specimen Frozen Section of the Vaginal Specimen

Frozen Section of the Vaginal Specimen Frozen Section of the Vaginal Specimen

Frozen section of the left ovarian mass:

Finding compatible with endometroid carcinoma

Frozen Section of the Vaginal Specimen Left Ovary : Endometrioid Carcinoma

Left Ovary : Endometrioid Carcinoma

Right Ovary : Stromal Luteoma

Right Ovary : Stromal Luteoma

Right Ovary : Stromal Luteoma

Pathologic finding in TAH BSO+ Right & Left Pelvic Pathologic finding in TAH BSO+ Right & Left Pelvic Lymph node +Lymph node +OmentectomyOmentectomy Specimen:Specimen:

Left Ovary: Endometrioid Carcinoma

Left Tube: Normal histology

Endometrium: Endometrioid Endometrial Adenocarcinoma (Grade 1)Adenocarcinoma (Grade 1)

Cervix: Chronic Papillary Cervitis

Right Ovary: Multiple Cystic Follicles StromalLuteoma

Right Tube: Normal histology

Pelvic Lymph nodes: Free From Metastasis

Omentum: Free From Metastasis

Left Ovary : Endometrioid Carcinoma Left Ovary : Endometrioid Carcinoma

Right Ovary : Multiple Cystic Follicles Left Ovary : Endometrioid Carcinoma

Left Ovary : Endometrioid Carcinoma Endometrium

Synchronous neoplasms occur within one year.Synchronous primary malignancies account for 0.7-1.8% of all gynecologic tumors .

Most common synchronous ovarian and endometrial cancers comprise 40-53% of all synchronous gynecologic malignancies.

Synchronous ovarian and endometrial cancers are found in 3.3-5% of all patients with endometrial cancer and in 2.7-10% of all patients with ovarian cancer and even in 12-50% of patients with ovarian cancer of endometrioid histology.Because endometrioid histology is the most common in both localizations.

differentiation between 3 clinical situations is often necessary: primary endometrial cancer with metastases to ovaries, primary ovarian cancer with metastases to endometrium or two synchronous primary cancers.

A precise diagnosis is important because these 3 situations are related to different prognosis and require different postoperative management.

Synchronous primary ovarian and Synchronous primary ovarian and endometrial cancers: a series of endometrial cancers: a series of cases and a review of literaturecases and a review of literature

Sylwia Dębska-Szmich, Urszula Czernek, Sylwia Dębska-Szmich, Urszula Czernek, Magdalena Krakowska, Marta Frąckowiak, Agnieszka Zięba, Rafał Czyżykowski

Chemotherapy Department of the Medical University of Lodz in 2013.

Abstract: We present 10 patients with synchronous ovarian and endometrial cancers who were treated at the Chemotherapy Department of the Medical University of Lodz in 2009-2013.

The most often reported symptom of the disease was abnormal vaginal bleeding. The range of the patients’ age was 48-62 and The range of the patients’ age was 48-62 and the median age was 56.

5 patients had stage I of ovarian cancer, single patients had stage IIA, IIB and IIIB, 2 patients had stage IIIC. 3 patients had I, 5 – II, and 2 – III stage of endometrial cancer.All patients had endometrioid type of endometrial cancer, 7 of them had also the same histological type of ovarian cancer.

Abstract: a median follow up was 13 months. One patient experienced relapse, all patients are alive.

Synchronous ovarian and endometrial cancers are usually diagnosed at an earlier stage, have lower histological grade and better prognosis than single cancers.

The most common histological type of both endometrial and ovarian cancers is endometrioidcarcinoma.

Survival outcome of women with Survival outcome of women with synchronous cancers synchronous cancers of of endometrium endometrium and ovary: a and ovary: a 10 10 year retrospective cohort study year retrospective cohort study

Yong Kuei Lim, Rama Padma, Lilian Foo, Yin Nin Chia, Philip Yam, John Chia, HS Khoo-Tan, SweePeng Yap, Richard Yeo

Department of Medical Oncology, National Cancer Centre, Singapore2013.

.

Objective: Synchronous occurrence of endometrial and ovarian tumors is uncommon, and they affect less than 10% of women with endometrial or ovarian cancers. The aim of this study is to describe the epidemiological and clinical factors; and survival outcomes of women with these cancers.

Methods: This is a retrospective cohort in Singapore. The sample consists of women with endometrial and epithelial ovarian cancers followed up over a period of 10 years from 2000 to 2009. The epidemiological and clinical factors include age at diagnosis, histology types, grade and stage of disease.

Results:75 patients with SEO cancers were identified. The median follow-up was 74 months. The incidence rate for synchronous cancer is 8.7% of OC and 4.9% of all EC diagnosed over this time frame. Mean age at diagnosis was 47.3 years old. The most common presenting symptom was AUB36.9% and 73.9% had endometrioid histology for both endometrial and ovarian cancers.78% presented were at early stages of 1 and 2. There presented were at early stages of 1 and 2. There were 13.6% cases of recurrence and the 5 year cumulative survival rate was at 84%.

Conclusion: majority of women afflicted with synchronous cancer of the endometrium and ovary were younger at age of diagnosis, had early stage of cancer and good survival.

ClinicopathologicClinicopathologic and survival and survival analyses of synchronous primary analyses of synchronous primary endometrial and epithelial endometrial and epithelial ovarian cancersovarian cancers

Hamdullah Sozen, Dogan Vatansever, Ahmet Cem Iyibozkur, MehmetOzsurmeli

Departments of Obstetrics and Gynecology and

Pathology, Istanbulmdullah Sozen

Faculty of Medicine, Istanbul University, Istanbul, Turkey 2015.

Aim: describe clinicopathologic characteristics, survival outcomes and the factors associated with recurrence in patients diagnosed with synchronous primary endometrial and epithelial ovarian cancers.

Material and Methods: In this retrospective study, 50 patients who were diagnosed with synchronous primary endometrial and epithelial ovarian cancers and underwent surgery between 1998 and 2010 were reviewed.

Results: the median age at the time of diagnosis was 53 years. The most common presenting symptom was abnormal uterine bleeding with a ratio of 36%.

54% of the patients had endometrioid type 54% of the patients had endometrioid type endometrial cancer and endometrioid type ovarian cancer. All patients were surgically staged and the majority of the patients were in stage I for both endometrial cancer (58%) and ovarian cancer (60%).

Results:one-third of the patients had a recurrence during the follow-up period a serous or clear-cell histopathologic type ovarian cancer and stage of endometrial cancer above I were found to be independent risk factors associated with development of recurrence.

Patients with endometrioid type endometriumhistology and endometrioid type ovarian histology had favorable prognosis with 120.00 months mean disease-free survival and 92% diseasefree survival rate at 36 months.

Conclusion: endometrioid/endometrioid type synchronous primary endometrial and ovarian cancer had different clinical histopathologiccharacteristics and favorable prognosis compared to the other histologic types of these cancers.

Histopathologic type of the ovarian cancer component, stage of endometrial cancer and component, stage of endometrial cancer and level of CA 125 at diagnosis were observed to have a great influence on the development of recurrence and survival of synchronous primary carcinomas of the endometrium and ovary.

Prognostic Factors in Women Prognostic Factors in Women With Synchronous Endometrial With Synchronous Endometrial and Ovarian Cancersand Ovarian Cancers

Taejong Song, MD, Seok Ju Seong, MD, PhD,Duk-Soo Bae, MD, PhD,Þ Jong-HyeokKim, MD, PhD,þ Dong Hoon Suh, MD, PhD,§ Keun-Ho Lee, MD, PhD, Sang-Yoon Park, MD, PhD,And Taek Sang Lee, MD, PhD

Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam.2014.

Objective: The purpose was to determine the prognostic factors in women with synchronous endometrial and ovarian cancers.

Methods: Medical records of 3240 patients with Methods: 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.

Results: 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%. pretreatment CA-125 and tumor stage of the ovary showed prognostic tumor stage of the ovary showed prognostic significance about PFS and OS , respectively.

Conclusions: Pretreatment CA-125 and tumor stage of the were independent prognostic factors for recurrence and survival.

Synchronous Endometrial and Synchronous Endometrial and Ovarian Cancer in Young Ovarian Cancer in Young Women: Case Report and Review Women: Case Report and Review of the Literatureof the Literature

ASKIN DOGAN ,BEATE SCHULTHEIS, GUNTHER A. REZNICZEK, ZIAD HILAL,CEM CETIN, GUNTHER HÄUSLER and CLEMENS B. TEMPFER

Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Bochum, Germany.2017.;

Abstract: Young women with EC have an increased risk of synchronous ovarian cancer. The prognosis of women with 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. She underwent TLH&BSO, and endometrium. She underwent TLH&BSO, and pelvic lymphadenectomy. Final histology revealed a synchronous bilateral endometrioid ovarian cancer. 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 (36%) of them being premenopausal or <50 years of age.

microsatellite instability and subsequent mutations in mismatch repair genes compatible with HNPCC were identified in(40%) women analyzed.analyzed.

The mean recurrence-free and overall survival times of young women with SEOC were 1.9 and 4.0 years.

Conclusion: Young women with EC have a high risk of synchronous ovarian cancer.

in young women with EC, bilateral salpingooophorectomy or careful histological assessment of both ovaries are recommended in order to confirm or rule out SEOC. order to confirm or rule out SEOC.

HNPCC testing should be offered to all women.

Synchronous endometrial Synchronous endometrial andand ovarian carcinomas: ovarian carcinomas: predictors ofpredictors of risk andrisk and associations associations withwith survival andsurvival and tumor tumor expression profilesexpression profiles

Linda E.Peter F. Rambau.Jennifer M. Koziak . Helen Steed. Martin Köbel

Department of Obstetrics and Gynecology, Lois Hole Hospital, Royal Alexandra Hospital, Canada.2017.

Purpose: SEOs are diagnosed in 10% of ovarian cancer patients. We examined predictors of SEOs, evaluated associations of SEOs with survival and characterized ovarian tumor profiles using immunohistochemistry.

Methods: We included patients with endometrioid(180) and clear cell (165) ovarian carcinoma (180) and clear cell (165) ovarian carcinoma identified from the Alberta Cancer Registry between 1979 and 2010 for whom we abstracted medical records and constructed tumor tissue microarrays (TMAs). A concurrent diagnosis of endometrial cancer was obtained from the medical chart. Protein expression in ovarian tumors of patients with and without SEOs was evaluated using Fisher’s exact test.

Results: Comparing 52 patients with SEO tumors to 293 patients with endometrioid or clear cell ovarian carcinomas, endometriosis at the ovary was the strongest predictor of decreased risk in multivariable models.

Premenopausal status and pre-treatment CA125 levels showed weaker associations. levels showed weaker associations.

There were no significant differences in survival between patients with or without SEO tumors. More patients with SEO tumors compared to endometrioid ovarian carcinoma were deficient in MLH1, PMS2 and PTEN.

Conclusions: Endometriosis may not be the mechanism by which SEO cancers arise. Altered tumor oncoprotein expression between women with and without SEOs indicates important biological differences although this did not translate into prognostic differences.

Synchronous primary cancers of Synchronous primary cancers of the endometrium and ovary in the endometrium and ovary in young women: A Korean young women: A Korean Gynecologic Oncology Group Gynecologic Oncology Group Study Study

Taejong Song,Seok Ju Seong , Duk-Soo Ba,DongHoonSuh,Dae-YeonKim,Myong CheolLim,TaekSangLee

Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea 2013.

Objective: Some authors have recommended the use of diagnostic laparoscopy as a pretreatment assessment step for conservative hormonal treatment in young women with EC.

Methods: 3240 patients with endometrial cancer who underwent primary surgery between 1995 and who underwent primary surgery between 1995 and 2010 from 7 institutions were retrospectively reviewed.

Low-risk endometrial cancer was defined as tumors without myometrial invasion; normal or benign-looking ovaries; normal CA125; grade 1endometrioid histology; and early stage endometrial cancer on pretreatment assessment.

Results: 50% were younger than 40 years of age. The incidence of synchronous ovarian cancer in young women with EC was 4.5% .In patients with low-risk endometrial cancer, synchronous cancers were not identified.

Conclusion: The incidence of synchronous ovarian Conclusion: The incidence of synchronous ovarian malignancies in young women with endometrial cancer was quiet low (4.5%). Therefore, diagnostic laparoscopy is not mandatory in patients with low-risk early stage endometrial cancer selected for conservative treatment to confirm the absence of ovarian malignancy.

Synchronous Ovarian and Synchronous Ovarian and Endometrial Endometrial CancerVanCancerVanInternational Multicenter CaseInternational Multicenter Case--Control Study Control Study

Florian Heitz, MD,Þ Frederic Amant, MD, Florian Heitz, MD,Þ Frederic Amant, MD, PhD,þ Christina Fotopoulou, MD, PhD, Marco J. Battista, MD, Pauline Wimberger, MD, PhD

Department of Gynecology, Charite , Campus Virchow ClinicYUniversity Hospital, Berlin 2013.

Objectives: This study aimed to compare the prognosis of patients with SEOC to matched controls with either EC or OC.

Methods: 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 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.

Results: The study cohort comprised 77, 132, and 126 patients with SEOC, EC, and OC, respectively. 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 but not the 5-year overall survival rates and did not differ between SEOC and OC.

Conclusions: 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.

Implication of genomic Implication of genomic characterization in synchronous characterization in synchronous endometrial and ovarian cancers endometrial and ovarian cancers of of endometrioidendometrioid histology histology

Angel Chao, Ren-Chin Wu, Shih-Ming JungAngel Chao, Ren-Chin Wu, Shih-Ming Jung

, Yun-Shien Lee, Shu-Jen Chen, Yen-Lung Lu

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan 2016.

Objectives: SEOCs present gynecologic oncologists with a challenging diagnostic puzzle: discriminating between double primary cancers and single primary cancer with metastasis. We aimed to determine the clonal relationship between simultaneously diagnosed endometrial and ovarian carcinomas.carcinomas.

Methods: Fourteen pairs of SEOCs of endometrioidtype and two pairs of SEOCs with disparate histologic types (control for dual primary tumors) were subjected to massively parallel sequencing (MPS) and molecular inversion probe microarrays.

Results: SEOCs harbored somatic mutationsshared by both uterine and ovarian lesions, indicative of clonality. High degree of chromosomal instability in the tumors from10 patients who received adjuvant chemotherapy, of whom9 had synchronous carcinomas with significantly overlapping copy number alterations (CNAs), suggestive of single primary tumors with metastasis. The clonal relationship determined by metastasis. The clonal relationship determined by genomic analyses did not agree with clinicopathological criteria in 11 of 14 cases. Minimal CNAs were identified in both ovarian and endometrial carcinomas in 4 patients, who did not receive adjuvant chemotherapy and experienced no recurrent diseases. In contrast, two of the 10 patients with chromosomally unstable cancers developed recurrent tumors.

Conclusion;Our findings support a recent paradigm-shifting concept that most SEOCs originate from a single tumor. It also casts doubt on the clinicopathological criteria used to distinguish between dual primary tumors and single primary tumor with metastasis. Testing of CNAs on SEOCs may help determining the need of CNAs on SEOCs may help determining the need of adjuvant therapy.

Synchronous Synchronous endometrioidendometrioidendometrial and ovarian cancer endometrial and ovarian cancer in a in a 3434--yearyear--old woman old woman

Patrícia Isidro Amaral, Abel Silva, Abílio Patrícia Isidro Amaral, Abel Silva, Abílio Lacerda, Carlos Barros

Centro Hospitalar Lisboa Central—Maternidade Dr Alfredo da Costa, Lisboa, Portugal 2015.

SUMMARY :A 34-year-old woman with lower abdominal pain of 1 year duration presented at the emergency department. On gynaecologicalexamination, she had a left and midline pelvic mass. A transvaginal ultrasound showed it to be a complex hypervascularised mass, with cystic and solid components on left adnexal region. Ectopic pregnancy and pelvic inflammatory disease were excluded. Serum levels of tumour marker CA125 and ROMA were increased. The MR showed a and ROMA were increased. The MR showed a complex mass, suggestive of primary fallopian tube or ovarian tumour. The patient underwent a total abdominal hysterectomy, bilateral salpingooophorectomy, pelvic and para-aortic lymph node dissection and subcolonicomentectomy. Histopathology revealed a synchronous endometrioid endometrial and ovarian cancer.

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