FIRMST abstract 2020.02

FIRMST2020-AB02
SIMULTANEOUSLY DEVELOPED UTERINE CARCINOSARCOMA AND ENDOMETRIOD OVARIAN CARCINOMA IN A 21-YEAR-OLD WOMAN

Anna Voronova
Perm State Medical University, Perm, Russian Federation

Aim: 
To present a clinical case of primary multiple malignant neoplasms of the female reproductive system at a young age

Keywords
Endometriosis; uterine carcinosarcoma; endometroid carcinoma
correspondence to: voronova.anna96@yandex.ru
Summary: 
Diagnosis and treatment of reproductive system primary multiple malignant neoplasms in young patients with complicated gynaecological anamnesis is an extremely difficult task. The combination of T3N1M0 uterine carcinosarcoma with highly-aggressive endometrioid ovarian carcinoma resulted in a fatal outcome despite combined treatment.
No conflict of interest declared
Article Information
Epub: 04.08.2020
Presented at FIRMST Conference, Moscow 2020
Peer reviewed by JS Bamrah, Ananthakrishnan Raghuraman, Soumit Dasgupta
Open Access- Creative Commons Licence CC-BY-ND-4.0

Methods: 
Retrospective analysis of clinical documentation and review of literature. 
Presentation
The patient presented with cramping pains in the lower abdomen and bloody vaginal discharge. A diagnosis of a giant necrotic endometrial polyp was made at polypectomy. Histologically signs of malignancy were found. 
Case History
She started menstruation from 12 years, which was irregular. She was given a diagnosis of endometriosis. In 2015 she had a missed abortion and between 2015-2017 she took an oral contraceptive. A week later she was admitted to hospital and a hysteroscopy was performed, and the contents of the uterine cavity were aspirated. Results of histological examination confirmed a malignant tumour of the endometrium.
She had a laparotomy 4 weeks later and her uterus and ovaries were removed along with iliac lymph node dissection on the left plus a subtotal resection of large omentum.

Histological examination: 
showed a uterine carcino-sarcoma spreading to external orifice. Metastasis was confirmed in the omentum, iliac lymph nodes on the left side and the right ovary. Staged at T3N1M0.
Over the next 5 months, she received 4 courses of chemotherapy (Paclitaxel, Carboplatin) and 2 courses of radiotherapy.
At her 3 month, post therapy staging PET / CT she was found to have metastases to the right lung, liver, and mesenteric tissue. She was then switched to second line therapy. She received 2 further courses with Docetaxel and Gemcitabine. A further staging CT showed metastasis to the liver, peritoneum, abdominal lymph nodes, lungs, and bones. She received chemotherapy with Pazopanib.
Immunohistochemical examination of ovaries confirmed highly aggressive endometrioid carcinoma of the right ovary.
Diagnosis: Uterus carcinosarcoma, endometrioid carcinoma of the right ovary
The patient did not continue further therapy due to her clinical and performance status, developed progressive malignant ascites requiring laparocentesis. She passed away 6 months from initial presentation and no post-mortem was performed. 

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