Rapid progression of synchronous ovarian and endometrial cancers with massive omental carcinomatosis

Abstract

We present a rare case of a 41-year-old woman with synchronous primary cancers of the endometrium and ovary, both in advanced stages. Palliative surgery with incomplete tumor debulking followed by the first trial of chemotherapy provided no treatment benefit to her prognosis and she died shortly thereafter. A 41-year-old woman, para 1, was referred to our department for prolonged and profuse menstrual bleeding, poor appetite and marked abdominal distension. Abdominal ultrasound and computed tomography showed a large left adnexal tumor accompanied by massive ascites and carcinomatosis (Fig. 1). The levels of tumormarkers, including cancer antigen (CA) 125, CA 19-9, and carcinoembryonic antigen (CEA), were 1588 U/ mL, 21 U/mL, and 1.4 ng/mL, respectively. During her operation, we noted a huge omental cake of about 35 cm (Fig. 2), a left ovarian tumorwith rectal serosa invasion, diffuse intraperitoneal (including bowels) tumor implantation, and massive ascites totaling about 6600 mL. The uterus, the contralateral ovary and tube, and the liver surface were not involved. Suboptimal debulking surgery was done (residual tumor size > 1 cm), and the estimated blood loss was 2000 mL. The microscopic findings included two synchronous tumors of the left ovary and endometrium. The histological types were mixed clear cell (moderately differentiated), endometrioid (well-differentiated) carcinoma of the left ovary (90% clear and 10% endometrioid), and mucinous (moderately differentiated) carcinoma of the endometrium, respectively. The contralateral ovary revealed a microscopic tumor implant. The final histopathological findings were synchronous ovarian clear celleendometrioid carcinoma and endometrial mucinous carcinoma, with massive omental carcinomatosis, without lymph nodes metastasis, FIGO IIIC (pT3cN1) (Figs. 3 and 4). She received adjuvant chemotherapy with carboplatin and taxol immediately after the operation. The levels of tumor