Synchronous primary carcinoma of uterine cervix and endometrium——single-center retrospective study

Background and objectives: Synchronous malignant tumors of the uterine body and the cervix are extremely rare. The stage of both malignancies at diagnosis has prognostic significance and there are only occasional reports in the literature. Materials and Methods: We performed a retrospective study of all cases, where surgery for synchronous primary cervical and endometrial cancers was done at the Clinic of Oncogynaecology, University Hospital – Pleven, Bulgaria for an 8-year period. Patients were followed-up until December 2019. We analyzed some clinico-pathological characteristics of both malignant conditions as demographical data and menopausal status of the patients, as well as the histological type and TNM 8 stage of both cancers; we tried to correlate them with the rates of overall survival. Results: We explored 1460 patients’ files and identified 6 cases of synchronous cervical and endometrial cancers. The mean age of the patients was 58 years (range 47-65). 5 of them (83.3%) were diagnosed in menopause. In 1 case (16.7 %) the size of the cervical cancer (CC) was > 4 cm (locally advanced disease), in 3 cases (50%) it was below 2 cm, and in the remaining 2 cases (33.3%) the CC was only microinvasive. The CC histology was squamous cell carcinoma without keratinization in 5 women (83.3%) and in 1 case (16.7%) adenosquamous. The histology of all endometrial cancers (EC) was endometroid adenocarcinoma and all of them were stage I. Conclusions: Co-existence of synchronous cancers of the uterine cervix and endometrium does not seem to worsen the prognosis of the patients and may even be beneficial: the symptoms of the EC may lead to earlier diagnosis of the synchronously existing malignant conditions.

Multiple primary malignancies; Synchronous multiple primary malignancies endometrial cancer; Cervical cancer; Treatment; Survival.

[1] SEER Program Code Manual, Third Edition. Bethesda (MD): National Cancer Institute. January 1998.

[2] Das S.: “Synchronous and metachronous cancers: An update”. Ann. Clin. Case Rep., 2017, 2,1388.

[3] Woods R.: “Registration”. Handbook of Medical Image Processing and Analysis, 2009, 495-497.

[4] Lin C., Yu M., Chu T., Lai H.: “Synchronous occurrence of primary neoplasms in the uterus with squamous cell carcinoma of the cervix and adenocarcinoma of the endometrium”. Taiwan. J. Obstet. Gynecol., 2006, 45, 336-339.

[5] Sun H., Lai C., Yen M., Wang P.: “Synchronous occurrence of primary neoplasms of the uterus with mucinous carcinoma of the cervix and endometrioid carcinoma of the endometrium”. Taiwan. J. Obstet. Gynecol., 2011, 50, 377-378.

[6] Gutiérrez-Palomino L., Romo-de los Reyes J.M., Pareja-Megía M. J., García-Mejido J.A.: “Triple synchronous primary gynaecological tumours. A case report”. CirugÍa Y Cirujanos (English Edition), 2016, 84, 69-72.

[7] Hascalik S., Celik O., Erdem G., Usta U., Alkan A., Karakas H.M., et al.: “Synchronous endometrial and cervical tumors in a 26-year-old nullipara: diagnostic modalities updated”. Gynecol. Obstet. Invest., 2005, 60, 171-176.

[8] Warren S., Gates O.: “A survey of the literature and statistical study”. Am. J. Cancer, 1932, 16, 1358-4142.

[9] Madhala D., Shanmugasundaram G., Narayanan S.S.C., Vijayaraghavan J.: “Synchronous primary carcinoma of cervix and endometrium”. Arch. Pathol. Lab. Med., 2017, 4, C33-C36.

[10] Xu M., Zhou F., Huang L.: “Concomitant endometrial and cervical adenocarcinoma”. Medicine (Baltimore), 2018, 97, e9596.

[11] Ohel G., Schwartz Z., Birkenfeld A., Anteby S.O., Schenker J.G.: “Second primary genital malignancies associated with endometrial cancer”. Arch. Gynecol., 1986, 239, 75-80.

[12] Eisner R.F., Nieberg R.K., Berek J.S.: “Synchronous primary neoplasms of the female reproductive tract”. Gynecol. Oncol., 1989, 33, 335- 339.

[13] Matlock D.L., Salem F.A., Charles E.H., Savage E.W.: “Syn-chronous multiple primary neoplasms of the upper female genital tract”. Gynecol. Oncol., 1982, 13, 271-277.

[14] Ayhan A., Yalçin O.T., Tuncer Z.S., Gürgan T., Küçükali T.: “Syn-chronous primary malignancies of the female genital tract”. Eur. J. Obstet. Gynecol. Reprod. Biol., 1992, 45, 63-66.

[15] Woodruff J.D., Solomon D., Sullivant H.: “Multifocal disease in the upper genital canal”. Obstet. Gynecol., 1985, 65, 695-698.

[16] Rose P.G., Herterick E.E., Boutselis J.G., Moeshberger M., Sachs L.: “Multiple primary gynecologic neoplasms”. Am. J. Obstet. Gynecol., 1987, 157, 261-267.