A Rare Case of Synchronous Endometrioid Bilateral Ovarian and Endometrial Adenocarcinoma with Endocervical Involvement

Abstract

Introduction: Synchronous primary gynecologic malignancies are rare and pose diagnostic challenges, particularly in young women. Accurate differentiation between synchronous primary tumors and metastatic disease is crucial because management and prognosis differ substantially. Case Presentation: A 26-year-old nulligravid woman undergoing evaluation for primary infertility was found to have bilateral ovarian cysts and endometrial thickening. Initial surgery revealed grade 1 endometrioid adenocarcinoma in both ovaries, with a minor papillary serous borderline component in the left ovary, and endometrioid adenocarcinoma identified on endocervical curettage. Imaging demonstrated bilateral ovarian lesions and a non-myoinvasive endometrial lesion. Genetic testing and mismatch repair analysis were negative. Positron emission tomography showed increased metabolic activity confined to the ovaries and endometrium, with no evidence of distant metastasis. After embryo cryopreservation, the patient underwent a radical hysterectomy, bilateral oophorectomy, pelvic lymphadenectomy, and omentectomy. Final histopathological examination confirmed synchronous stage IA, grade 1 endometrioid endometrial carcinoma and stage IB, grade 1 endometrioid ovarian carcinoma. She received three cycles of adjuvant carboplatin-paclitaxel chemotherapy and remained disease-free after 10 months of follow-up. Conclusions: This case highlights that synchronous ovarian and endometrial carcinomas, although rare, can occur in very young women. Persistent ovarian cysts and suspicious imaging findings should prompt comprehensive evaluation to facilitate early diagnosis and appropriate management, even in patients of reproductive age.