Coexisting ovarian malignancy in young women with endometrial cancer.
OBJECTIVE
In premenopausal women with endometrial cancer, ovarian preservation may be a consideration. Our objective was to examine the occurrence of coexisting ovarian malignancy and to identify predictors of adnexal involvement.


METHODS
With institutional review board approval, a retrospective chart review was conducted of young women with endometrial cancer identified at 4 affiliated institutions from 1996 to 2004.


RESULTS
Among 102 young women (aged 24-45 years) who underwent hysterectomy for endometrial cancer, 26 (25%) were found to have coexisting epithelial ovarian tumors: 23 were classified as synchronous primaries, and 3 as metastases. Ovarian cancer histology was endometrioid in 92% of cases. Among the 26 cases of coexisting ovarian involvement, 12 (46%) had grade 1 endometrial cancer on preoperative biopsy, 4 (15%) had normal preoperative imaging of the adnexa, and 4 (15%) had benign-appearing ovaries at the time of intraoperative assessment. On final pathology, 18 of 26 cases (69%) occurred in patients with grade 1 endometrial cancers, and 15 (58%) occurred with inner myometrial invasion. Our study further highlights the risk of conservative management with 1 case of ovarian cancer diagnosed 9 months after hysterectomy with ovarian conservation for a stage IA, grade 1 endometrial cancer and a case of advanced endometrial cancer metastatic to the ovaries developing 3 years after successful resolution of a grade 1 endometrial cancer treated with megestrol acetate (Megace).


CONCLUSIONS
Careful preoperative and intraoperative assessment of the adnexa is mandatory in young women with endometrial cancer. Those who desire ovarian preservation should be counseled regarding the high rate of coexisting ovarian malignancy.
Walsh
Christine
C
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, UCLA and Cedars-Sinai Medical Centers, Los Angeles, California 90048, USA.
Holschneider
Christine
C
Hoang
Yen
Y
Tieu
Khai
K
Karlan
Beth
B
Cass
Ilana
I
D000328:Adult; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000628:therapy; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D010052:Ovariectomy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome