Synchronous mucinous cystadenoma ovary, leiomyoma uterus and mucinous adenocarcinoma cervix infiltrating into uterine leiomyoma: a rare case report
Keywords:Adenocarcinoma, Cystadenoma, Leiomyoma, Mucinous
The overall incidence of synchronous female genital tract malignancies is 0.63%. The most frequently observed synchronous neoplasms are those of the ovary together with the endometrium. Cervical and ovarian malignancies are exceedingly rare. We present the case of a female patient who complained of abdominal distention and pain abdomen. A cervical pap smear was performed, and it showed inflammation and atrophic changes. USG abdomen revealed findings consistent with pyometra. Repeated dilatation and curretage for resolving the pyometra was attempted, but it yielded mucinous fluid only. Another USG abdomen was done, which showed a cervical growth. The patient was taken up for staging laparotomy. Per operatively, no growth could be identified in the cervix. However, dense adhesions of the cervix with the bladder were present. A bilateral salpingo-oophorectomy specimen was sent for intraoperative cytology, and showed mucinous cystadenoma, ovary. Further, the completion total hysterectomy specimen was sent for histopathology. Sections showed adenocarcinoma, cervix and leiomyoma, uterus. The cervical adenocarcinoma showed infiltration into the uterine leiomyoma. Thus, we document a very rare case involving a patient who presented with three coexistent tumours involving bilateral ovaries and uterus. To our knowledge, this is the first reported case of the combination. Accurate diagnosis as separate independent primary tumours or as primary tumour associated with its metastasis, and identification the site of origin in secondary tumours has important prognostic implications and is necessary for appropriate staging and treatment.
Srivastava K, Zahra F. Synchronous primary malignancy of ovary and cervix with different histopathology: a rare presentation. The Internet J Gynecol Obstetr. 2009;12(2):4.
Kambi DP, Mallikarjuna M, Santosh C, Abhishek V. Synchronous malignancies of ovary, fallopian tube and cervix: A rare case. Internat J Biomedic Advanc Res. 2013;4(9):676-9.
Ayhan A, Yalçin OT, Tuncer ZS, Gürgan T, Küçükali T. Synchronous primary malignancies of the female genital tract. Eur J Obstet Gynecol Reprod Biol. 1992;45(1):63-6.
Katke RD, Gadekar S, Pagare P. A rare case of carcinoma of ovary with carcinoma of cervix. J Case Reports. 2014;4(1):217-20.
Amalinei C. Morphogenesis and differentiation of the female genital tract. Genetic determinism and epithelium-stromal interactions. Rev Med Chir Soc Med Nat Iasi. 2007;111(1):200-9.
Matias-Guiu X, Lagarda H, Catasus L, Bussaglia E, Gallardo A, Gras E, et al. Clonality analysis in synchronous or metachronous tumours of the female genital tract. Int J Gynecol Pathol. 2002;21(3):205-11.
Tavassoli FA, Devilee P. World Health Organization Classification of Tumours, Pathology and genetics. Tumours of the breast and female genital organs. Lyon: IARC Press; 2003.
Amalinei C, Balan R, Ivan L, Socolov R, Socolov D, Cotutiu C. Multiple primary malignant neoplasms- case report. Central Europ J Medic. 2006;1(1):87-98.
Dioun SM, Soliman PT. Laparoscopic hysterectomy with morcellation for a suspected uterine fibroid resulting in dissemination of cervical adenocarcinoma: A case report. Gynecol Oncol Rep. 2015;12:5-6.
Woodruff JD, Julian CG. Multiple malignancy in the upper genital canal. Am J Obstet Gynecol. 1969;103(6):810-22.
Eifel P, Hendrickson M, Ross J, Ballon S, Martinez A, Kempson R. Simultaneous presentation of carcinoma involving the ovary and the uterine corpus. Cancer. 1982;50(1):163-70.
Ulbright TM, Roth LM. Metastatic and independent cancers of the endometrium and the ovary: a clinicopathologic study of 34 cases. Hum Pathol. 1985;16(1):28-34.
Prat J, Matias-Guiu X, Barreto J. Simultaneous carcinoma involving the endometrium and the ovary. A clinicopathologic, immunohistochemical, and DNA flow cytometric study of 18 cases. Cancer. 1991;68(11):2455-9.
Klemi PJ, Grönroos M. Endometrioid carcinoma of the ovary. A clinicopathologic, histochemical, and electron microscopic study. Obstet Gynecol. 1979;53(5):572-9.
Kline RC, Wharton JT, Atkinson EN, Burke TW, Gershenson DM, Edwards CL. Endometrioid carcinoma of the ovary: retrospective review of 145 cases. Gynecol Oncol. 1990;39(3):337-46.
Zaino RJ, Unger ER, Whitney C. Synchronous carcinomas of the uterine corpus and ovary. Gynecol Oncol. 1984;19(3):329-35.