Triple simultaneous primary gynecological malignancies in a 56-year-old patient

Triple synchronous tumour of female genital tract: cervical squamous cell carcinoma, right ovarian dermoid cyst and left ovarian benign Brenner tumour

Synchronous tumours of two different histological type are not uncommon in the female genital tract. But triple synchronous tumours of three or more different histological types is extremely rare. We describe a case of a 48-year-old female patient who presented with cervical growth and bilateral ovarian masses. Pathological evaluation of the surgical specimen revealed synchronous cervical squamous cell carcinoma, right ovarian dermoid cyst and left ovarian benign Brenner tumour. The patient was treated as per the carcinoma cervix protocol and is disease free at 1-year follow-up. To our knowledge this is the first report of such an occurrence. This occurrence cannot be related to any known hereditary syndromes, hence may be considered a chance association. Although rare, awareness of such an occurrence is important for the surgeon, radiologist and the surgical pathologist for proper diagnosis and management.

Synchronous Well-differentiated Endometrioid Adenocarcinoma and Leiomyosarcoma of the Uterus With Pulmonary Metastasis in a 50-Yr-Old Woman: A Case Report and Review of Literature

The most common synchronous gynecologic malignancies are endometrial and ovarian cancers. However, synchronous endometrial adenocarcinoma and uterine leiomyosarcoma are extremely rare. We report the case of a 50-yr-old woman who was diagnosed with concomitant endometrial adenocarcinoma and uterine leiomyosarcoma. The sarcomatous neoplasm was positive for anti-smooth muscle actin and CD10, and focally positive for Cytokeratin AE1/AE3 and Cytokeratin Cam 5.2. She underwent total abdominal hysterectomy with bilateral salpingoopherectomy followed by radiation, brachytherapy, and chemotherapy. Three years later, she presented with cough and dyspnea and was found to have pulmonary metastasis. These tumor cells were positive for anti-smooth muscle actin, Cytokeratin AE1/AE3, Cytokeratin Cam 5.2, and epithelial membrane antigen, and therefore a diagnosis of lung metastasis from myometrial leiomyosarcoma was made. She received chemotherapy postoperatively. Currently, the patient has multiple lung metastases, is on Megestrol Acetate and is clinically well. This is the first reported case of concomitant uterine malignancies with pulmonary metastases and a long follow-up of 9 yr. It is important to rule out carcinosarcoma as a differential diagnosis in such patients.

Coexistence of Cervical Leiomyosarcoma and Gastric-Type Adenocarcinoma In Situ with Extensive Extension to the Endometrium and Fallopian Tube

Cervical leiomyosarcoma is known to be rare from the previous reviews of a large number of malignant cervical tumors. The patient was a 66-year-old woman with irregular vaginal bleeding. She underwent modified radical hysterectomy and bilateral salpingooophorectomy. Histopathologically, we diagnosed the coexistence of uterine cervical leiomyosarcoma and cervical gastric-type adenocarcinoma in situ with endometrial lesions that had continuous and skip patterns and fallopian tubal lesions with a partial lesion. To the best of our knowledge, cases of synchronous leiomyosarcoma and cancers have not often been reported; only two cases of synchronous cervical leiomyosarcoma and cervical squamous cell carcinoma have been published. This case is the first presentation of coincidental primary cervical leiomyosarcoma and cervical gastric-type adenocarcinoma in situ. Additionally, we considered cervical gastric-type adenocarcinoma in situ with continuous lesions on the endometrium and skip lesions on the left fallopian tube.

Triple Synchronous Primary Neoplasms of the Cervix, Endometrium, and Ovary: A Rare Case Report and Summary of All the English PubMed-Indexed Literature

The incidence rate of triple or more synchronous primary neoplasms of the female genital system is exceedingly uncommon. To the best of our knowledge, only 13 such cases have been reported in the PubMed-indexed English literature. Herein, we report a single case of triple synchronous primary neoplasms of the cervix, endometrium, and left ovary with three distinct histological patterns that were not reported previously. Moreover, we briefly present a summary table of all the English PubMed-indexed cases of triple or more synchronous primary neoplasms of the female genital system (n = 13).

Synchronous uterine adenocarcinoma and leiomyosarcoma - a case study

Synchronous gynecological cancers are rarely described. Those cases account for approximately up to 6% of female genital tract malignancies. The presence of synchronous endometrial adenocarcinoma and gynecological tract neoplasia is rare - the most commonly described is synchronous adenocarcinoma and endometrial ovarian cancer (accounting for 15-20% of ovarian neoplasia and 5% of endometrial cancers). Concomitant uterine carcinosarcoma and ovarian cancer, or endometrial adenocarcinoma are extremely rare. Up till now, only 3 cases of synchronous adenocarcinoma and leiomyosarcoma were described. In the present study a case of 60-year-old woman diagnosed with synchronous endometrial adenocarcinoma and leiomyosarcoma uteri is described. As the preoperative evaluation revealed endometrial adenocarcinoma G2 with intermediate-risk of lymph node metastasis and synchronous leiomyosarcoma G3, total hysterectomy with bilateral salpingo-oophorectomy and systemic lymphadenectomy was performed showing no lymphatic involvement. In the postoperative evaluation the patient was qualified to adenocarcinoma low recurrence-risk group (adenocarcinoma G1 with no LVSI, FIGO IA) - no further radiotherapy was required. However, as synchronous leiomyosarcoma G3 was diagnosed, we decided to refer the patient for adjuvant chemotherapy. Contemporary recommendation on the diagnosis and treatment of uterine carcinomas, especially uterine leiomyosarcomas, is also described in this paper. The presented case showed that diagnosis and treatment of women with uterine tumors should be individualized as in the same case an extremely rare cancer type can be present which, consequently, changes the treatment regimen and prognosis.

Triple synchronous primary malignancies of the colon, endometrium and kidney in a patient with Lynch syndrome treated via minimally invasive techniques

Coexisting primary malignancies have been described at length in the literature. While double primary malignancies are relatively common, three synchronous primary malignancies are extremely rare.

We describe a case of a 60-year-old woman undergoing surgery for a known endometrial carcinoma. The patient also had a renal mass that was identified as a clear cell renal cell carcinoma and an additional lesion in the colon that was a mucinous adenocarcinoma. Further genetic testing of the patient revealed a deleterious MSH6 mutation suggestive of Lynch syndrome. The patient had all tumors addressed by minimally invasive techniques at the same operative intervention.

It is important to consider hereditary cancer syndromes in women with a strong family history presenting with synchronous multiple primary malignancies. A multidisciplinary surgical approach is key to best practices and optimal patient outcomes.

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Consider synchronous tumors in patients presenting with a genetic risk by history.

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Consider synchronous tumors in patients presenting with a deleterious mutation.

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Minimally invasive surgical options will optimize patient outcomes.

Synchronous uterine adenocarcinoma and leiomyosarcoma: A rare case report causing a clinical conundrum

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We present a rare case of concurrent uterine adenocarcinoma and leiomyosarcoma.

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Literature review confirms this is a very rare combination of synchronous tumors.

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We discuss therapeutic challenges in synchronous gynecologic malignancies.

Introduction

Synchronous gynecologic primary cancers are uncommon. When present, the most frequent malignancies consist of endometrial and ovarian carcinomas. Here we report an exceedingly rare case of concurrent uterine adenocarcinoma and leiomyosarcoma.

Case presentation

A 60 year-old female presented with four years of postmenopausal bleeding. An endometrial sampling showed grade 2 endometrioid adenocarcinoma. She proceeded with hysterectomy that contained an anterior endometrial mass and a posterior myometrial mass. The final pathology demonstrated concurrent uterine adenocarcinoma and leiomyosarcoma.

Discussion

To the best of our knowledge, this is the third reported case of simultaneous uterine adenocarcinoma and leiomyosarcoma. As this presentation is infrequent with limited literature, this caused a clinical management conundrum. Unfortunately, the follow-up PET scan suggested possible recurrence or metastasis three months after the surgery.

Conclusion

Simultaneous uterine adenocarcinoma and leiomyosarcoma is an exceptionally rare event. As the experience is limited, a multidisciplinary approach in managing these patients may be the best option currently available.

Surveillance and Care of the Gynecologic Cancer Survivor

BACKGROUND

Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of fertility, contraception, and vasomotor symptoms; and genetic counseling.

METHODS

This is a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. We searched databases including PubMed, Cochrane, and Scopus using the search terms gynecologic cancer, cancer surveillance, and cancer survivor and reached a consensus for articles chosen for inclusion in the review based on availability in the English language and publication since 2001, as well as key older articles, consensus statements, and practice guidelines from professional societies. However, we did not undertake an extensive systematic search of the literature to identify all potentially relevant studies, nor did we utilize statistical methods to summarize data. We offer clinical recommendations for the management of gynecologic cancer survivors based on review of evidence and our collective clinical experience.

RESULTS

Key messages include the limitations of laboratory studies, including CA-125, and imaging in the setting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-related vasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general health screening, fertility preservation, and contraception.

CONCLUSIONS

A holistic approach to care extending beyond cancer treatment alone benefits gynecologic cancer survivors. In addition to surveillance for cancer recurrence and late treatment side effects, survivors benefit from guidance on hormonal, contraceptive, and fertility management and promotion of cardiovascular, bone, brain, and sexual health.

Triple Synchronous Primary Gynecologic Carcinomas

Double synchronous primaries are known to occasionally occur in gynecologic cancers. Cases of triple or quadruple synchronous primaries, with only 4 case reports in the literature, are extremely rare. The authors report the case of a 49-year-old para 2-0-0-2 woman who presented for surgical management of metastatic ovarian adenocarcinoma diagnosed at an outside institution. On examination of the surgical specimen, 3 synchronous primary carcinomas with multiple histologic features were identified within the ovaries, uterus, and cervix. Although rare, the possibility of triple synchronous primary malignancies should be considered when evaluating gynecologic malignancies.

Co-existence of three rare gynecological tumors in a 79-year-old woman

The occurrence of two primary tumors simultaneously is relatively common. However, the occurrence of three kinds of gynecological tumors simultaneously is extremely rare. Here we presented a 79-year-old woman who had simultaneously three primary gynecological tumors which were relatively uncommon. Those tumors were myxoid leiomyosarcoma and endometrial mucinous adenocarcinoma in the uterus and a Leydig cell tumor in the right ovary. Uterine myxoid leiomyosarcoma is a very rare and aggressive variant of uterine sarcoma despite of its minimal even no atypia and a little mitotic activity. Mucinous endometrial adenocarcinoma is also a rare subtype which comprise only 0.6-5% of uterine cancers. Leydig cell tumor is a very rare ovarian tumor which is composed entirely or predominantly of Leydig cell.

[Endometrial and endocervical lesions associated with pseudomyxoma peritonei: a case report]

The association of a pseudomyxoma peritonei with a mucinous tumor of the appendix and/or the ovary is regularly reported in the literature. However, in this context, endometrial or endocervical lesions remain exceptional. We report the case of a 57-year-old patient, with pseudomyxoma peritonei associated with a low-grade mucinous neoplasia of appendix and both ovaries. The systematic sampling of endometrium and endocervix showed small segments of intestinal epithelium admixed with native epithelium. Histological and immunohistochemical characteristics of this epithelium were quite comparable to those observed in the appendix and ovaries. The endocervical and endometrial lesions might represent an implantation of mucinous epithelium from appendix, emphasizing the capacity of this epithelium to implant at a distance from the original lesion.

Triple synchronous primary cervical, endometrial and ovarian cancer with four different histologic patterns

BACKGROUND

Double synchronous primary cancers of gynecological cancers is a common event. However, triple synchronous primary gynecological cancers is an extremely rare event.

CASE

A 50-year-old woman, para 0-0-0-0 was admitted to the hospital with a complaint of menorrhagia for 2 months. The preoperative evaluation and diagnosis was myoma uteri with bilateral ovarian tumor. Subtotal hysterectomy with bilateral salpingo-oophorectomy, and omentectomy were performed. The postoperative and pathologic findings were adenosquamous carcinoma of the endocervix, adenocarcinoma of the endometrium, low malignant potential of the right ovary and mucinous cystadenocarcinoma of the left ovary. She received a complete course of whole pelvic radiation. Unfortunately, she died from pulmonary embolism.

CONCLUSION

The occurrence of triple synchronous gynecological cancers is a rare and unique event deserving further studies.

Three synchronized neoplasms of the female genital tract: an extraordinary presentation

INTRODUCTION

We report a case of unusual co-existence of multiple primary neoplasms of female genital tract.

CASE

A 62-year-old gravida 2, para 2 was referred with spotting and vaginal discharge for about 6 months. Fractionate curettage was performed and documented endocervical squamous cell carcinoma in situ. Subsequently total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed. Final pathological report demonstrated cervical squamous cell carcinoma, right ovarian Brenner tumor, left ovarian granulosa tumor and endometrial polyps.

DISCUSSION

Multiple primary neoplasms of female genital tract is a well-recognized yet rare occurrence. Although the presented case is probably an incidental event, the pathogenesis of the neoplastic process affecting the tissues with different embryological origin needs further research and evaluation. It is important to distinguish multiple primary neoplasms from metastatic disease because of the fact that overall survival as well as treatment would vary considerably.