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| LETTER TO THE EDITOR |
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| Ahead of print publication |
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Synchronous benign Brenner's tumor of the ovary with leiomyoma and endometrial adenocarcinoma in a postmenopausal female
Jude Ogechukwu Okoye
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| Date of Submission | 05-Oct-2019 |
| Date of Acceptance | 07-Jan-2020 |
| Date of Web Publication | 22-Jul-2020 |
Correspondence Address:
Jude Ogechukwu Okoye,
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State
Nigeria
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jcrt.JCRT_831_19
Sir,
I read with keen interest the article titled, “Synchronous benign Brenner's tumor of the ovary with leiomyoma and endometrial adenocarcinoma in a postmenopausal female.”[1] In postmenopausal women with synchronous tumors, total abdominal hysterectomy with bilateral salpingo-oophorectomy is as important as identifying the underlying genetic or familial correlates of the disease. Having synchronous tumors, involving the endometrium and the ovary, may be linked to Lynch syndrome (LS), also known as hereditary nonpolyposis colorectal cancer.[2],[3],[4] Apart from endometrial and ovarian tumors, individuals with LS (≤50 years) are at risk of developing breast, urinary tract, and/or other abdominal cancers. From the information provided in the article, it is unclear whether the patient was prepped for any family history of colorectal or gastric cancer in other to rule out LS. Testing for microsatellite instability (MSI; NR21, NR24, BAT25, BAT26, MONO27) and loss of expression of mismatch repair gene mutations (MMR; MSH2, and MSH6), using immunohistochemistry, may have offered more insights into the origin of the disease since the patient just turned 50 years.[2] The stage of endometrial cancer (Grade 1) and nature of the Brenner tumor (benign with cystic changes) suggest that the two entities may be primary tumors and with time, a malignant tumor could have developed in the left ovary. This is suspicious of LS. Unfortunately, complementary biochemical assays (carbohydrate antigen 125, carbohydrate antigen 19–9 or carcino-embryonic antigen) were not carried out to rule out any presence of malignant cells in the ovaries. Although there are some conflicting reports as to the usefulness of radiation therapy in endometrial cancer as a form of treatment, it is believed that tumor positive lymph nodes following lymphadenectomy should inform the decision on whether to employ radiation therapy (internal or external pelvis) or not. It is also unclear if the authors carried out lymphadenectomy or positron-emission tomography/computed tomography to rule out distant metastasis. This might impact on patient survival postsurgery. Molecular profiling of such an individual will not only allow for better prognostication and understanding of the pathogenesis behind the synchronic tumors but also enable clinicians to identify and preempt metachronous tumors, possibly through adjuvant therapy.[5]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| > References | |  |
| 1. | Gaur JH, Hassan MJ, Elahi AA, Khetrapal S, Khan S, Jetley S. Synchronous benign Brenner's tumor of ovary with leiomyoma and endometrial adenocarcinoma in a postmenopausal female. J Cancer Res Ther 2019;15:1418-20.  |
| 2. | Takeda T, Banno K, Yanokura M, Anko M, Kobayashi A, Sera A, et al. Synchronous endometrial and ovarian cancer in lynch syndrome with a MSH2 germline mutation: A case report. Mol Clin Oncol 2018;9:479-84. |
| 3. | Kim MK, Song SY, Do IG, Kim SH, Choi CH, Kim TJ, et al. Synchronous gynecologic malignancy and preliminary results of Lynch syndrome. J Gynecol Oncol 2011;22:233-8. |
| 4. | Soliman PT, Broaddus RR, Schmeler KM, Daniels MS, Gonzalez D, Slomovitz BM, et al. Women with synchronous primary cancers of the endometrium and ovary: Do they have Lynch syndrome? J Clin Oncol 2005;23:9344-50. |
| 5. | Charo LM, Plaxe SC. Recent advances in endometrial cancer: A review of key clinical trials from 2015 to 2019. [version 1; peer review: 2 approved] F1000 Research 2019, (F1000 Faculty Rev);8:849. doi: 10.12688. |
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