Dogan Askin, Schultheis Beate, Rezniczek Günther A, Hilal Ziad, Cetin Cem, Häusler Günther, Tempfer Clemens B
Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Bochum, Germany.
Department of Hematology and Oncology, Ruhr-Universität Bochum, Bochum, Germany.
Anticancer Res. 2017 Mar;37(3):969-978. doi: 10.21873/anticanres.11406.
Young women with endometrial cancer (EC) have an increased risk of synchronous ovarian cancer. The prognosis of women with synchronous endometrial and ovarian cancer (SEOC) is good. A high proportion of affected women have hereditary non-polyposis colon cancer syndrome (HNPCC).
We present the case of a 45-year-old woman with histologically proven endometrioid adenocarcinoma of the endometrium (pT1B, G2, R0 without lymphovascular space invasion). She underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Final histology revealed a synchronous bilateral endometrioid ovarian cancer (pT1A, G2, R0). HNPCC analysis by immunohistochemistry showed no microsatellite instability in MSH2, MSH6, MLH1, and PMS2. No adjuvant therapy was administered, clinical follow-up with regular gynecological examinations was recommended. In a systematic literature review, 2,904 cases of women with SEOC were identified with 1,035 (36%) of them being premenopausal or <50 years of age. The proportion of women with SEOC among all reported EC cases was 842/23,498 (3%) and the proportion of young women with SEOC among all reported EC cases was 261/23,498 (1%). In summary, microsatellite instability and subsequent mutations in mismatch repair genes compatible with HNPCC were identified in 6/15 (40%) women analyzed. The mean recurrence-free and overall survival times of young women with SEOC were 1.9 (min 0.2, max 3) and 4.0 (min 0.2, max 22.1) years, respectively.
Young women with EC have a high risk of synchronous ovarian cancer. Thus, in young women with EC, bilateral salpingo-oophorectomy or careful histological assessment of both ovaries are recommended in order to confirm or rule out SEOC. HNPCC testing should be offered to all women.
患有子宫内膜癌（EC）的年轻女性患同步性卵巢癌的风险增加。同步性子宫内膜癌和卵巢癌（SEOC）女性的预后良好。高比例的受影响女性患有遗传性非息肉病性结肠癌综合征（HNPCC）。
我们报告了一名45岁女性的病例，其经组织学证实为子宫内膜样腺癌（pT1B，G2，R0，无淋巴管间隙浸润）。她接受了腹腔镜子宫切除术、双侧输卵管卵巢切除术和盆腔淋巴结清扫术。最终组织学检查发现同步性双侧子宫内膜样卵巢癌（pT1A，G2，R0）。通过免疫组织化学进行的HNPCC分析显示，MSH2、MSH6、MLH1和PMS2中无微卫星不稳定性。未给予辅助治疗，建议进行定期妇科检查的临床随访。在一项系统的文献综述中，共识别出2904例SEOC女性病例，其中1035例（36%）为绝经前或年龄小于50岁。在所有报告的EC病例中，SEOC女性的比例为842/23498（3%），在所有报告的EC病例中，年轻SEOC女性的比例为261/23498（1%）。总之，在分析的15例女性中发现6例（40%）存在与HNPCC相符的微卫星不稳定性及错配修复基因的后续突变。年轻SEOC女性的平均无复发生存期和总生存期分别为1.9年（最小值0.2，最大值3）和4.0年（最小值0.2，最大值22.1）。
患有EC的年轻女性患同步性卵巢癌的风险很高。因此，对于患有EC的年轻女性，建议进行双侧输卵管卵巢切除术或对双侧卵巢进行仔细的组织学评估，以确认或排除SEOC。应向所有女性提供HNPCC检测。
