Synchronous primary malignancies and pre-cancers affecting entire hysterectomy specimen: A report of an unfortunate case

Synchronous tumours of the female genital tract are rare, accounting for approximately 1%–2% of all gynaecological malignancies involving simultaneous independent primary malignancies. Synchronous tumours in the ovary and endometrium are the most common combination. We report on a 58-year-old postmenopausal woman who presented with bleeding per vaginum for 1.5 months with no prior menstrual complaints. On per vaginal examination, a mass was felt in the pelvis. Ultrasonography revealed a mass of 8 cm × 9 cm in size filling the entire uterine cavity. Contrast enhanced computed tomography showed a multilobate mass in the pelvis, replacing the whole uterus and cervix, with heterogeneous enhancement and internal necrosis. Bilateral ovaries were not visualised separately. The radiological impression suggested an endometrial carcinoma. Wertheim's hysterectomy was subsequently performed. On microscopic examination, the uterine mass revealed a malignant mixed Müllerian tumour (carcinosarcoma) of the endometrium, along with a high-grade serous carcinoma of the left ovary and left fallopian tube. The right fallopian tube showed adenocarcinoma in situ. The patient had an unusual past history of multiple system comorbidities, a few of which were continuing and for which she was receiving medical treatment.