A rare case of synchronous ovarian clear cell carcinoma and endometrioid adenocarcinoma of the uterine corpus abstract
The concurrence of two genital tumors is relatively uncommon. They represent 1-6% of all genital malignancies. Endometrial and ovarian malignancies show the commonest simultaneous occurrence among female reproductive organs. Approximately 10% of all patients with ovarian cancer are diagnosed to have endometrial cancer synchronously, and 5% the other way around. The simultaneous presence of primary cancers of the ovary and the endometrium, based on the sparse literature, is not well documented. Most tumors manifest in various morphological forms of adenocarcinoma, including serous, mucinous, clear cell, or endometrioid, and show similar histology in both endometrium and ovary. Based on our knowledge, simultaneous primary ovarian and endometrial carcinoma with different subtypes has not yet been reported. Case presentation: This case describes a 64-year-old, postmenopausal woman presented with abnormal uterine bleeding, anemia and elevated tumor markers to the Gynecological Unit. Ultrasonography showed a bulky uterus with a large solid cystic mass in the left ovary. Subsequently the patient underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingoopherectomy. Histological examination of the ovarian mass revealed features of clear cell carcinoma with macroscopic tumor extension to the peritoneum. Sections from the endometrium showed grade II endometrioid adenocarcinoma with invasion into myometrium and cervical stroma. Coexistent endometriosis was also noted on the anterior surface of the uterus. Both fallopian tubes, right ovary and pelvic lymph nodes were free of malignancy. Conclusion: The pathogenesis of primary synchronous endometrial and ovarian cancer is unclear. The theory of a secondary Müllerian system explains that the epithelium of ovaries, uterus, cervix and fallopian tubes have shared molecular receptors. These receptors respond to the carcinogenic stimulus in the same manner and consequently lead to the development of synchronous multiple primary malignancies with similar histology.This theory may not be useful in the case of concurrent cancers with dissimilar histology. Therefore, a different underlying mechanism should be sought. Further, there is another hypothesis that histologically benign endometriotic lesions may harbor genetic defects, which can progress to malignancy in a step-wise fashion and the greatest risk of malignant transformation is associated with endometrioid and clear cell carcinoma. To our knowledge, this is the first reported case of synchronous ovarian and endometrial cancer with different histology which can disclose various pathogenesis of synchronous genital tumors