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

• Published in: Journal of ovarian research Vol. 14; no. 1; p. 87
• Main Authors: Shimizu, Maho, Yamanaka, Keitaro, Azumi, Maho, Tomimoto, Masako, Washio, Keiichi, Takahashi, Ryosuke, Nagamata, Satoshi, Murata, Yuka, Yamasaki, Yui, Terai, Yoshito
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.06.2021; BioMed Central; BMC
• Subjects: Abdomen; Ascites; Cancer; Carcinoma; Carcinoma in Situ - diagnostic imaging; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Case Report; Case reports; Diagnosis; Endometrial cancer; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Endometrium; Female; Humans; Hysterectomy; Laparoscopy; Lesions; Lymph nodes; Lymphatic Metastasis - diagnostic imaging; Lymphatic Metastasis - pathology; Magnetic Resonance Imaging; Menopause; Metastases; Metastasis; Middle Aged; Neoplasms, Multiple Primary - diagnostic imaging; Neoplasms, Multiple Primary - pathology; Neoplasms, Multiple Primary - surgery; Ovarian cancer; Ovarian carcinoma; Ovarian Neoplasms - diagnostic imaging; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Ovariectomy; Post-menopause; Postmenopausal women; Postmenopause; SEIC; Serous endometrial intraepithelial carcinoma; Serous ovarian cancer; Surgery; Tumor staging; Tumors; Ultrasonography; Uterine cancer; Uterus; Womens health; Serous endometrial intraepithelial carcinoma; SEIC; Serous ovarian cancer
• ISSN: 1757-2215; 1757-2215
• DOI: 10.1186/s13048-021-00835-8

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. 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. 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.