Concomitant endometrial and pancreatic cancers.

65-year-old woman presented with a 2-month history of postmenopausal bleeding. Her past medical history was significant for hypertension, type 2 diabetes, and a remote history of pulmonary embolism, and her surgical history was significant for a thyroidectomy for benign disease and a hip replacement. On physical examination, she was found to have a mass protruding through the cervix. Biopsy revealed a poorly differentiated grade 2 endometrioid cancer of the uterus, with a suspected sarcomatous component. Subsequent imaging also identified a pancreatic mass (Figure 1). The patient underwent surgical exploration, beginning with a modified radical abdominal hysterectomy, bilateral salpingooophorectomy, and left pelvic lymph node sampling. The patient’s uterus was approximately the size of a 12to 14-week gravid and boggy uterus with necrotic friable tissue at the fundus and in the left parametrial region. There was also a necrotic left pelvic external iliac lymph node. The patient had a 3 × 4-cm vaginal mass on the anterior vaginal wall. Since resection of the vaginal mass would have required an extensive dissection of the entire bladder and the near-entire removal of the anterior vagina, the vaginal cuff was closed with a plan to locally irradiate this focus of disease. In the upper abdomen, the patient was found to have a mass along the margin of the right lobe of her liver, which was locally resected. Pathologically, this lesion was consistent with a neuroendocrine tumor. This mass was believed to be related to the pancreatic lesion, and an aggressive surgical approach was used (1, 2), given that the endometrial disease was controlled. Surgical treatment of these lesions required a distal pancreatectomy and splenectomy with resection of adjacent nodes and resection of an additional focus in the liver. Total gross resection of the neuroendocrine disease was achieved. The patient tolerated these surgical procedures without significant complications and was discharged from the hospital 7 days later. Presented at the gynecology tumor conference on June 17, 2009