Abstract
When confronting synchronous tumors of the ovaries and endometrium, it is very difficult to establish a differential diagnosis between the presence of two independent tumors and metastasis from ovary to endometrium or vice versa and yet very important because of the different prognosis and management of these two entities. The most frequent symptom of these patients is abnormal vaginal bleeding but occasionally they can be asymptomatic and occur incidentally. Cases: Two female patient, at the ages of 54 and 48 years, accepted to our hospital with postmenopausal bleeding. Histopathologic examination of the endometrial curettings revealed endometrioid adenocarcinoma for both of our cases and total abdominal hysterectomy, bilateral salpingoooferectomy and regional lymph node dissection was performed. Subsequently, synchronous endometrioid adenocarcinomas were found at the endometrium and left ovary in the 54 years old patient and endometrium and bilateral ovaries in the 48 years old one. Discussion: Synchronous tumor at the ovary can be seen 8 % of patients with the endometrium adenocarcinoma. Less than 5 cm diameter for ovarian tumor, bilateral ovarian invasion, depth of the myometrial invasion, vascular invasion, involvement of the tuba uterina, immunohystochemistry and DNA flow cytometry, are criteria and methods for differential diagnosis but their values are limited, although molecular studies seem promising. In this report we present two cases of synchronous endometrioid adenocarcinomas of the endometrium and ovaries due to their controversial nature and diagnostic difficulties.
References
- 1-Rosai J:Female Reproductive System, Chapter 19. In: Ackerman 's Surgical Pathology ed. Rosai J, St Louis Mosby,2004 ninth ed: 1483-1763 2-Ronnett BM, Zaino RJ, Ellenson LH, Kurman RJ: Endometrial Carcinoma, Chapter 12. In: Blaustein 's Pathology of the Female Genital Tract,ed.Kurman RJ, Springer,2002 5 th ed:501-61 3- Guirguis A, Elishaev E, Sung -Hee Oh, at ah Use of gene expression profiles to stage concurrent endometrioid tumors of the endometrium and ovary. Gynecol Oncol 2008; 108: 370-76 4-Zaino R, Whitney C, Brady MF, at al: Simultaneously detected endometrial and ovarian carcinomas-A Prospective clinicopathologic study of 74 cases: A Gynecologic Oncology Group Study. Gynecol Oncol 2001;' 83: 355-62 5-Kır G, Karateke A, Aker F: Eş zamanlı over ve endometrium tümörlerinin klinik ve histopatolojik özellikleri. Kad Doğ Der 2003; l(4):296-99 6-Soliman PT, Slomovitz BM, Broaddus RR, at al: Synchronous primary cancers of the endometrium and ovary: a single instution review of 84 cases. Gynecol Oncol 2004; 94:456-62 7- Pearl ML, Johnston CM, Frank TS,at al: Synchronous dual primary ovarian and endometrial carcinomas. IntJ Gynecol Obstet 1993; 43:305-12 8-Halperin R, Zehavi S, Hadas E,at al: Simultaneous carcinoma of the endometrium and ovary vs. endomtrial carcinoma with ovarian metastases: A clinical and immunohistochemical determination. IntJ Gynecol Cancer 2003; 13::32-7 9-Irving JA, FRCPC, CatasusL, Gallardo A, at al: Synchronous endometrioid carcinomas of the uterine corpus and ovary: alterations in the B-catenin (CTNNB1) patway are associated with independent primary tumors and fovar able prognosis. Hum Path 2005; 36: 605-19 10-Doğan Ekici Al, Küçükali T, Salman MC, Ayhan A: Triple simultaneous Primary gynecological malignancies in a 56-year- old patient. IntJ Gynecol Cancer 2006; 16: 1936-50 11- Scully RE, Young RH, Clement PB. Tumors of the ovary malldevelopedgonads,fallopian tube,and broad ligament. Atlas of tumor pathology. Bethesta, MD: Armed Forces Institute of Pathology; 1998
- 12-Fujii H, Matsumoto T, Yoshida M, at ah Genetics of synchronous uterine and ovarian endometrioid carcinoma: Combined analyses of loss of heterozygosity, PTEN, mutation and microsatellite instability. Hum path 2002; 33:421-28
Abstract
Endometrium ve överlerde eş zamanlı benzer morfolojik özellikte tümör varlığında endometriumdan övere metastaz, överden endometriuma metastaz veya bağımsız iki primer tümör varlığının ayrımını yapmak oldukça zordur. Ancak bu ayrımın yapılması prognoz ve tedavileri farklı olduğu için önemlidir. Bu tümörlere sahip hastalarda klinik olarak en sık görülen semptom anormal vajinal kanamadır. Bazı olgular asemptomatik olup tesadüfen tanı alabilirler. Olgular: Postmenapoz kanama şikayetiyle hastanemize başvuran 54 ve 48 yaşındaki olgularımıza kavum uteri küretaj uygulanmış ve materyallerin patolojik incelemesinde her iki olgu endometrioid tipte adenokarsinom tanısı almıştır. Sonrasında total abdominal histerektomi+bilateral salpingo-ooferektomi ve bölgesel lenf nodu diseksiyonu uygulanmış olan olgularımızın patolojik değerlendirmelerinde 54 yaşındaki olgunun endometrium ve sol överinde 48 yaşındaki olgunun ise endometrium ve her iki överinde eş zamanlı endometrioid tipte adenokarsinom saptanmıştır. Tartışma: Endometrium karsinomlu hastaların %8'inde eş zamanlı over tümörü izlenmektedir. Benzer morfolojik özellikteki bu tümörlerde ayrım için överdeki tümörün 5 cm'in altında olması, bilateral ovaryan tutulum, myometrial invazyon derinliği, vaskûler invazyon veya tuba tutulumu gibi belli kriterler, immünohistokimya ve DNA flow sitometrîk çalışmalar kullanılmakla birlikte sınırlı bir değerlendirme yapılabilmektedir. Moleküler çalışmalar bu konuda umut vaad etmektedir. Ancak halen bu tümörlerin etyopatogenezinin tartışmalı olması ve tanıda büyük zorluklar içermesi nedeniyle endometrium ve överde benzer morfolojik özellikte eş zamanlı tümör saptanan olgularımız literatür eşliğinde sunulmuştur.
References
- 1-Rosai J:Female Reproductive System, Chapter 19. In: Ackerman 's Surgical Pathology ed. Rosai J, St Louis Mosby,2004 ninth ed: 1483-1763 2-Ronnett BM, Zaino RJ, Ellenson LH, Kurman RJ: Endometrial Carcinoma, Chapter 12. In: Blaustein 's Pathology of the Female Genital Tract,ed.Kurman RJ, Springer,2002 5 th ed:501-61 3- Guirguis A, Elishaev E, Sung -Hee Oh, at ah Use of gene expression profiles to stage concurrent endometrioid tumors of the endometrium and ovary. Gynecol Oncol 2008; 108: 370-76 4-Zaino R, Whitney C, Brady MF, at al: Simultaneously detected endometrial and ovarian carcinomas-A Prospective clinicopathologic study of 74 cases: A Gynecologic Oncology Group Study. Gynecol Oncol 2001;' 83: 355-62 5-Kır G, Karateke A, Aker F: Eş zamanlı over ve endometrium tümörlerinin klinik ve histopatolojik özellikleri. Kad Doğ Der 2003; l(4):296-99 6-Soliman PT, Slomovitz BM, Broaddus RR, at al: Synchronous primary cancers of the endometrium and ovary: a single instution review of 84 cases. Gynecol Oncol 2004; 94:456-62 7- Pearl ML, Johnston CM, Frank TS,at al: Synchronous dual primary ovarian and endometrial carcinomas. IntJ Gynecol Obstet 1993; 43:305-12 8-Halperin R, Zehavi S, Hadas E,at al: Simultaneous carcinoma of the endometrium and ovary vs. endomtrial carcinoma with ovarian metastases: A clinical and immunohistochemical determination. IntJ Gynecol Cancer 2003; 13::32-7 9-Irving JA, FRCPC, CatasusL, Gallardo A, at al: Synchronous endometrioid carcinomas of the uterine corpus and ovary: alterations in the B-catenin (CTNNB1) patway are associated with independent primary tumors and fovar able prognosis. Hum Path 2005; 36: 605-19 10-Doğan Ekici Al, Küçükali T, Salman MC, Ayhan A: Triple simultaneous Primary gynecological malignancies in a 56-year- old patient. IntJ Gynecol Cancer 2006; 16: 1936-50 11- Scully RE, Young RH, Clement PB. Tumors of the ovary malldevelopedgonads,fallopian tube,and broad ligament. Atlas of tumor pathology. Bethesta, MD: Armed Forces Institute of Pathology; 1998
- 12-Fujii H, Matsumoto T, Yoshida M, at ah Genetics of synchronous uterine and ovarian endometrioid carcinoma: Combined analyses of loss of heterozygosity, PTEN, mutation and microsatellite instability. Hum path 2002; 33:421-28
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | May 1, 2008 |
| Published in Issue | Year 2008 Volume: 39 Issue: 4 |