#331 : Bilateral Endometriomas Masquerading Synchronous Endometrial and Ovarian Cancer (SEOC) in an Infertile Female

Background and Aims: Endometriomas are diagnosed in clinical practice by imaging (mostly ultrasound) in females presenting with infertility. CA-125 level is an adjuvant investigation which may be indicative of endometriosis. A few research questions that are yet to be answered. Is ultrasound a sufficient modality to diagnose endometrioma? Is there any cut off as far as the measurement of endometrioma is concerned to step up the imaging modality to MRI?

Synchronous endometrial and ovarian cancer (SEOC) is a rare phenomenon with an incidence of 1.4 - 3.8%. Mostly in SEOC, the ovarian endometroid carcinoma arises in background of endometriosis with endometrial carcinoma of lower stage and grade in premenopausal age group.

Method: A 32-year-old female with Severe Dysmenorrhea and Secondary infertility had clinical evidence of bilateral endometriomas of 4-5 cm on ultrasound. She underwent hysterolaparoscopy. On hysteroscopy, endometrium was polypoidal and vascular, looking suspicious for malignancy. Hence endometrial biopsy was taken. On laparoscopy, B/L ovaries were enlarged, multiloculated, solid-cystic with granular surface and adhered in POD, decision for staging laparotomy with frozen section was taken. Frozen section was suggestive of Borderline tumor. Eventually, fertility sparing surgical staging was done (BSO + infracolic omentectomy + peritoneal biopsies). Peritoneal cytology was negative for malignant cells.

Results: Histopathological examination revealed Endometriod adenocarcinoma grade 1a/1a in both endometrial and ovarian components with no involvement of omentum and peritoneum. Immunohistochemistry demonstrated P53 to be moderately positive in endometrium and strongly positive in ovary, whereas ER, PR was positive in both tumors of endometrium and ovary and WT-1 negative in ovaries. Hence diagnosed as SEOC and not metastatic tumor. Mirena was inserted in follow up and repeat biopsy is awaited.

Conclusion: Suspicion of ovarian endometroid carcinoma must born in mind in cases with large bilateral endometriomas with long-standing endometriosis.