Synchronous tumors of the female genital tract: A 20-year experience in a single center

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Gabriel Muszyński
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1 Ginekol Pol. 20, 85, -5 Synchronous tumors of the female genital tract: A 20-year experience in a single center Synchroniczne nowotwory narządu płciowego kobiety: 20-letnie doświadczenie jednego ośrodka 2 3 Dokuz Eylul University Faculty of Medicine, Department of Obstetrics&Gynecology, Turkey 2 Dokuz Eylul University Faculty of Medicine, Department of Pathology, Turkey 3 Dokuz Eylul University Faculty of Medicine, Department of Oncology, Turkey Abstract Objective: To evaluate the clinicopathological characteristics and the clinical outcome of synchronous malignant neoplasms of the female reproductive tract. Material and Methods: Patients who were operated and diagnosed with synchronous malignant tumor of the genital system (n=25) at the Dokuz Eylul University Department of Obstetrics and Gynecology, Gynecologic Oncology Unit between 992 and 202 were included into this study. Recurrent, metastatic and metachronously detected tumors were not included. Age at diagnosis, parity, menopausal status, hormone use, presenting sign or symptoms and the clinical outcomes were evaluated. Results: 20 of 25 patients had endometrial-ovarian cancer. The mean age at diagnosis was 53,6 years. The most common presenting symptom was abnormal uterine bleeding. The median follow-up duration for all patients was 69 months. Overall survival for all patients was 87 months and 8 months for patients with endometrial-ovarian cancer. 5-year survival rate was 73% for all patients and 68% for patients with endometrial-ovarian cancer. Conclusions: Endometrial-ovarian cancer togetherness is the most common in synchronous gynecologic malignancies. They occur at a younger age and have more favorable prognosis than metastatic primary gynecologic tumors. Key words: outcome / genital tracts / synchronous tumor / Correspondence to: Bahadir SAATLI Dokuz Eylul University Faculty of Medicine, Department of Obstetrics&Gynecology Balçova, İzmir, TURKEY bahadir.saatli@deu.edu.tr phone: Otrzymano: Zaakceptowano do druku: Nr 6/20 Polskie Towarzystwo Ginekologiczne

2 Ginekol Pol. 20, 85, -5 Streszczenie Cel pracy: Celem pracy była patologiczna oraz kliniczna ocena synchronicznych nowotworów dróg rodnych. Materiał i metody: Do badania włączono pacjentki, u których stwierdzono złośliwe synchroniczne nowotwory dróg rodnych (n=25 ) i które były z tego powodu leczone operacyjnie w Klinice Położnictwa i Ginekologii na Oddziale Onkologii Ginekologicznej Uniwersytetu 9 Eylul w Izmirze (Turcja) w okresie od 992 do 202 roku. Pacjentki, u których stwierdzono guzy nawrotowe, przerzutowe synchroniczne bądź metasynchroniczne były wykluczone z badania. W pracy oceniono wiek pacjentek w momencie postawienia diagnozy, ich dzietność, status menopauzalny, ewentualną obecność endometriozy i stosowanie leków hormonalnych, jak również obecne objawy podmiotowe i przedmiotowe oraz wyniki kliniczne. Wyniki: U 20 z 25 pacjentek stwierdzono współwystępowanie raka trzonu macicy i jajnika. Średnia wieku w momencie postawienia diagnozy wynosiła 53,6 lat. Najczęstszym objawem było zaś nieprawidłowe krwawienie z dróg rodnych. Średni czas obserwacji chorych wynosił 69 miesięcy. Całkowite przeżycie w badanej grupie wyniosło 87 miesięcy, natomiast u pacjentek, u których stwierdzono współwystępowanie raka trzonu macicy i jajnika wynosiło ono 8 miesięcy. Odsetek przeżyć pięcioletnich w całej grupie wynosił 73%, zaś w grupie chorych, u których stwierdzono współwystępowanie raka trzonu macicy i jajnika wynosiło ono odpowiednio 68%. Wnioski: Wśród złośliwych synchronicznych nowotworów dróg rodnych współwystępowanie raka trzonu macicy i jajnika jest najczęstsze. Złośliwe nowotwory synchroniczne są stwierdzane we wcześniejszym wieku i mają korzystniejszą prognozę niż pierwotne nowotwory dróg rodnych dające przerzuty. Słowa kluczowe: drogi rodne / / / Introduction Materials and methods i ii iii iv v 2 Polskie Towarzystwo Ginekologiczne Nr 6/20

3 Ginekol Pol. 20, 85, -5 Results,,, Table I. Synchronous malignant neoplasm Primary Site n % Ovarian + endometrial Ovarian + cervical Ovarian + endometrial + cervical Endometrial + tubal Endometrial + vulvar Total Table II. Clinicopathological features of the synchronous primary endometrial and ovarian cancers. Patient Age Endometrial cancer Ovarian cancer Survival Last (years) Histology Stage/Grade Histology Stage (months) Status. 5 Endometrioid Ia/G Endometrioid Ia 78 Alive 2. Endometrioid Ib/G Mucinous IIIc 79 Alive Endometrioid Ib/G Mucinous Ic 80 Death*. 5 Endometrioid Ib/G Serous Ia 78 Alive Endometrioid Ia/G3 Endometrioid Ia 68 Alive Endometrioid Ib/G2 Clear cell IIIc 36 Death* Endometrioid Ib/G2 Serous IIIb 76 Death* 8. 9 Endometrioid Ib/G Serous IIIa 37 Alive 9. 6 Endometrioid Ia/G Serous IIb Death** Endometrioid Ia/G Serous IIIc 3 Death**. Endometrioid Ib/G2 Clear cell IIc 5 Alive Endometrioid Ib/G2 Serous IIIc Alive 3. 9 Endometrioid Ia/G Clear cell Ic 70 Alive. 7 Endometrioid Ia/G Endometrioid Ia 78 Alive 5. 0 Endometrioid Ia/G2 Mucinou IIIc 75 Alive 6. Endometrioid Ia/G2 Endometrioid Ia 69 Alive Endometrioid Ib/G2 Serous Ic 6 Death* Mucinous + squamous Ib/G2 Endometrioid Ia 33 Alive Mucinous Ib/G2 Endometrioid IIIc Alive Clear cell Ib/G3 Clear cell Ia 83 Alive * the cause of death is recurrence of the disease; ** the cause of death is non-gynecologic malignancy Nr 6/20 Polskie Towarzystwo Ginekologiczne 3

4 Ginekol Pol. 20, 85, -5 Discussion, Figure. Overall survival for patients with synchronous primary endometrial and ovarian cancer patients. Data analysis was performed using Kaplan-Meier methods.... Polskie Towarzystwo Ginekologiczne Nr 6/20

5 Ginekol Pol. 20, 85, -5 Conclusion Authors Contribution. Bahadır Saatli concept, analysis and interpretation of data, revised article critically. 2. Nuri Yildirim article draft, corresponding author, interpretation of data, concept, assumptions, study design. 3. Ali Cenk Ozay acquisition of data, analysis and interpretation of data.. Meral Koyuncuoglu - acquisition of data, analysis and interpretation of data. 5. Binnaz Demirkan assumptions, study design, acquisition of data. 6. Uğur Saygılı - revised article critically, concept. References. Matlock DL, Salem FA, Charles EH, Savage EW. Synchronous multiple primary neoplasms of the upper female genital tract. Gynecol Oncol. 982, 3, Schoenberg BS, Greenberg RA, Eisenberg H. Occurrence of certain multiple primary cancers in females. J Natl Cancer Inst. 969, 3, Ayhan A, Yalcin OT, Tuncer ZS, [et al.]. Synchronous primary malignancies of the female genital tract. Eur J Obstet Gynecol Reprod Biol. 992, 5, Zaino R, Whitney C, Brady M, [et al.]. Simultaneously detected endometrial and ovarian carcinomas: a prospective clinicopathologic Study of 7 cases: a Gynecologic Oncology Group Study. Gynecol Oncol. 200, 83, Eisner RF, Nieberg RK, Berek JS. Synchronous primary neoplasms of the female reproductive tract. Gynecol Oncol. 989, 33, Woodruff JD, Solomon D, Sullivant H. Multifocal disease in the upper genital canal. Obstet Gynecol. 985, 65, Ulbright T, Roth L. Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 3 cases. Hum Pathol. 985, 6, Scully RE, Young RH, Clement PB. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. Atlas of tumor pathology. Bethesda, MD: Armed Forces Institute of Pathology Montoya F, Martin M, Schneider J, [et al.]. Simultaneous appearance of ovarian and endometrial carcinoma: a therapeutic challenge. Eur J Gynaecol Oncol. 989, 0, Ree YS, Cho SH, Kim SR, [et al.]. Synchronous primary endometrial and ovarian cancer with three different histologic patterns: a case report. Int J Gynecol Cancer. 2003, 3, Eifel P, Hendrickson M, Ross J, [et al.]. Simultaneous presentation of carcinoma involving the ovary and the uterine corpus. Cancer. 982, 50, Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assn. 958, 53, Gungor T, Kanat-Pektas M, Ustunyurt E, Mollamahmutoglu L. Synchronous primary tumors of the female genital tract: a single center experience. Arch Gynecol Obstet. 2009, 279 (5), Prat J, Matias-Guiu X, Barreto J. Simultaneous carcinoma involving the endometrium and the ovary. Cancer. 99, 68, Shenson DL, Gallion HH, Powell DE, Pieretti M. Loss of heterozygosity and genomic instability in synchronous endometrioid tumors of the ovary and endometrium. Cancer. 995, 76, Fujita M, Enomoto T, Wada H, [et al.]. Application of clonal analysis. Differential diagnosis for synchronous primary ovarian and endometrial cancers and metastatic cancer. Am J Clin Pathol. 996, 05, Lin WM, Forgacs E, Warshal DP, [et al.]. Loss of heterozygosity and mutational analysis of the PTEN/MMAC gene in synchronous endometrial and ovarian carcinomas. Clin Cancer Res. 998,, Ricci R, Komminoth P, Bannwart F, [et al.]. PTEN as a molecular marker to distinguish metastatic from primary synchronous endometrioid carcinomas of the ovary and uterus. Diagn Mol Pathol. 2003, 2, Moreno-Bueno G, Gamallo C, Perez-Gallego L, [et al.]. Beta-catenin expression pattern, betacatenin gene mutations, and microsatellite instability in endometrioid ovarian carcinomas and synchronous endometrial carcinomas. Diagn Mol Pathol. 200, 0, Kaneki E, Oda Y, Ohishi Y, [et al.]. Frequent microsatellite instability in synchronous ovarian and endometrial adenocarcinoma and its usefulness for differential diagnosis. Hum Pathol. 200, 35, Soliman P, Slomovitz B, Broaddus R. Synchronous primary cancers of the endometrium and ovary: a single institution review of 8 cases. Gynecol Oncol. 200, 9, Chiang YC, Chen CA, Huang CY, [et al.]. Synchronous primary cancers of the endometrium and ovary. Int J Gynecol Cancer. 2008, 8 (), Tong SY, Lee YS, Park JS, [et al.]. Clinical analysis of synchronous primary neoplasms of the female reproductive tract. Eur J Obstet Gynecol Reprod Biol. 2008, 36 (), Authors statement party, as understood according to the Act in the matter of copyright and related rights of February 99, Official Journal 2006, No. 90, Clause 63, with respect to the text, data, tables and illustrations (graphs, figures, photographs); a financial or personal relationship which unjustly affects his/her actions associated with the publication of the manuscript; in the publication of the manuscript are revealed in the text of the article; Nr 6/20 Polskie Towarzystwo Ginekologiczne 5

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