METASTAZIRANJE ENDOMETRIJSKOG KARCINOMA U JAJNIK ILI ISTODOBNI PRIMARNI KARCINOMI ENDOMETRIJA I JAJNIKA – PRIKAZ BOLESNICE

Suzana Katalenić Simon, Josip Valetić, Ines Krivak Bolanča, Anita Škrtić, Josip Valetić

Primarni karcinom endometrija najčešća je maligna neoplazma ženskoga spolnog sustava. Prvotni simptomi, kada se i dijagnosticira u početnom stadiju bolesti, jesu nepravilna i/ili produljena krvarenja u premenopauzi ili krvarenja u postmenopauzi. Ostali su simptomi boli u zdjelici ili abdomenu ili abnormalni Papanicolaouov test. Bolesnice su najčešće u postmenopauzalnom razdoblju, ali ni žene generativne dobi nisu isključene. Radovi su pokazali da žene generativne dobi s dijagnosticiranim karcinomom endometrija imaju povišen rizik i od istodobne bolesti karcinoma jajnika i nasljednoga nepolipoznog karcinoma kolona. Upravo je entitet istodobnoga primarnog karcinoma endometrija i jajnika velika dijagnostička zamka jer ne postoje jedinstveni histološki algoritam ni kirurški postupnik, a potrebno ga je odvojiti od primarnog karcinoma jajnika i metastatskog širenja karcinoma endometrija u jajnik radi povoljnije prognoze i mogućnosti poštednijega kirurškog zahvata u mlađih bolesnica te očuvanja fertiliteta. U radu prikazujemo bolesnicu u dobi od 49 godina, s anamnestičkim podacima o obilnijim krvarenjima i postojanju ciste na jajniku, kod koje se nakon intenzivnih i naglih boli te zbog sumnje na rupturu ciste pristupilo hitnom laparoskopskom zahvatu. Zbog intraoperativnoga citološkog nalaza sa sumnjom na maligni proces i pozitivnoga patohistološkog nalaza operacija je konvertirana u laparotomiju. Detaljnom patohistološkom analizom uz imunohistokemijsku dopunu dijagnosticirana je rasadnica (metastaza) endometrioidnog adenokarcinoma endometrija.

Primary endometrial cancer is the most common malignant neoplasm of the female reproductive system. It is most commonly detected in the first stage of the disease. The most frequent initial symptoms are irregular or prolonged bleeding in premenopausal or bleeding in postmenopausal women. Other symptoms are pain in the pelvis or abdomen, or abnormal Pap smear. Patients are most often in postmenopausal period of life but women in generative age are not excluded. Dif-ferent researches have shown that women of generative age with endometrial cancer have an in-creased risk of the synchronous disease of ovarian cancer and hereditary non-polypoid colon can-cer. This is exactly corroborated by the fact that primary cancer in the reproductive system of women may occur at the same time, especially in endometrial cancer and in ovarian cancer. The entity of the synchronous primary cancer of endometrium and ovary is a large diagnostic trap because there is no unique histological algorithm or unique attitude for surgical procedure. How-ever,, it is necessary to separate this entity from primary ovarian cancer and metastatic endome-trial cancer in the ovary because of its better prognosis and possibility for less aggressive surgery in younger patients with preservation of fertility. We present a 49-year-old patient with history data on abundant bleeding and the existence of ovarian cyst. After intense and severe pain, and because of the suspicion of the rupture of the cyst, the emergency laparoscopic surgery was done. Intraoperative cytological analysis raised doubt about malignant process. Intraoperative histolog-ical finding was positive for endometrioid malignant process. Operation was converted to lapa-rotomy. Detailed histopathological analysis, complemented with immunohistochemical proce-dure, diagnosed metastasis of endometrioid adenocarcinoma of endometrium.