Synchronous ovarian endometrioid adenocarcinoma with a functioning stroma and endometrial endometrioid adenocarcinoma by different loss of heterozygosity findings

Mucinous epithelial ovarian tumors generally have estrogenic stroma, although the frequency of endometrioid adenocarcinoma with functioning stroma is very low. And while synchronous development of carcinomas in the endometrium and ovaries is a fairly common phenomenon, the distinction of a single clonal tumor with metastasis from two independent primary tumors may present a diagnostic challenge. We present a rare case of a 31-year-old woman with endometrioid adenocarcinoma of the ovary with functioning stroma and endometrial endometrioid adenocarcinoma who showed symptoms of virilization. Her preoperative levels of serum testosterone and estradiol were as high as 553 ng/dL and 177 pg/mL, respectively, and her serum gonadotropin levels were suppressed. After surgery, the serum levels of testosterone and estradiol decreased and that of follicle-stimulating hormone increased.

To develop a mean of differentiating a single tumor with metastasis from synchronous primary ovarian and endometrial cancers, we performed a microsatellite analysis. Twenty-five dinucleotide microsatellite markers were selected, and microsatellite analysis was performed by a high-resolution method using fluorescence-labeled polymerase chain reaction and laser scanning.

In this case, both ovarian carcinoma and endometrial carcinoma demonstrated loss of heterozygosity (LOH). However, the LOH findings of the ovarian tumor and endometrial tumor were different.

Loss of heterozygosity analysis may be helpful to differentiate synchronous primary ovarian and endometrial cancers from a single tumor with metastasis.