APPLICATION OF CLONAL ANALYSIS - DIFFERENTIAL-DIAGNOSIS FOR SYNCHRONOUS PRIMARY OVARIAN AND ENDOMETRIAL CANCERS AND METASTATIC CANCER

Simultaneous involvement of the endometrium and the ovary by carcinoma is a familiar problem in the routine practice of surgical pathology, Such cases may be considered either examples of a single primary carci noma with metastasis or as synchronous primary neoplasms. The distinct ion beta een these two possibilities is made based on clinicopathologi c observations, and therefore may not be definitive. In the present st udy, the authors used molecular techniques to analyze the clonal compo sition of five cases of concurrent adenocarcinomas of the endometrium and ovary that were clinicopathologically diagnosed as synchronous pri mary tumors. Patterns of X-chromosome inactivation, mutations in the K -ras gene, mutations or allelic loss of the p53 gene, or human papillo mavirus detection were identical in both endometrial and ovarian lesio ns in three of the cases suggesting that those three cases represented single primary tumors with metastases. In both of the other two cases , the patterns of X-chromosome inactivation clearly demonstrated the p resence of independent primary tumors. The application of molecular te chnology may play an important role for the differential diagnosis bet a een synchronous primary carcinomas and a single carcinoma with metas tasis.