Synchronous Endometrial and Ovarian Tumors: Diagnostic Challenges and the Role of Integrated Molecular Classification – A Case Report

Background: Synchronous endometrial and ovarian tumors (SEOC) are rare, representing approximately 3–10% of gynecologic cancers [1]. They are defined by the simultaneous occurrence of malignant tumors in both the endometrium and the ovary and constitute the most common form of synchronous gynecologic malignancies [2,3]. It’s associated with a better prognosis than metastatic forms affecting a single organ [4]. Case Presentation: We report the case of a 49-year-old nulligravid woman with a family history of colorectal cancer in a first-degree relative. She presented with chronic pelvic pain. Clinical examination was unremarkable. Pelvic ultrasound revealed endometrial thickening of 15 mm with an intracavitary lesion, a left solid-cystic adnexal mass with papillary projections, a cystic right ovary, and minimal ascites. Serum CA-125 level was elevated at 357 IU/mL. Pelvic magnetic resonance imaging confirmed a non-invasive endometrial mass and bilateral ovarian masses suspicious for malignancy, associated with moderate ascites without visible peritoneal implants. Diagnostic hysteroscopy and laparoscopy revealed an exophytic endometrial mass, an enlarged exophytic left ovary, a cystic right ovary, and ascites. Endometrial, ovarian, and peritoneal biopsies suggested a FIGO stage II endometrioid endometrial carcinoma associated with an undifferentiated ovarian carcinoma, FIGO stage IC. The patient underwent total hysterectomy with bilateral salpingo- oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and appendectomy. Final pathology confirmed an endometrioid carcinoma infiltrating two-thirds of the myometrium, bilateral ovarian involvement, and omental carcinomatosis, with negative lymph nodes and positive ascitic cytology (pT3c). Postoperative pathological staging was performed according to the pTNM classification, resulting in a final stage of pT3c.Four cycles of adjuvant chemotherapy were administered, with no evidence of recurrence on follow-up imaging. Conclusion: SEOC remains a diagnostic and therapeutic challenge. Accurate diagnosis requires an integrated approach combining histopathology, molecular analysis, and clinical features to guide optimal management.