ABSTRACT

Metastases from extragenital organs to uterus are very rare. Such metastatic disease is usually diagnosed at autopsy or in patients with known primary malignancies. A 68 years old woman complaining of vaginal bleeding was examined and ultrasound examination was performed. Collection in uterine cavity and a mass with heterogenous echogenity localized in douglas pouch was determined in ultrasonography. Endometrial sampling was resulted as adenocarcinoma. Gastroscopic and rectosigmoidoscopic test results were normal. A mass with the size of 5.5x5 cm at the right adnexial location and a mass with the size of 6x4 cm at the left adnexial location were seen at pelvic MRI and both masses were containing solid and cystic areas. Laparotomy was performed. In exploration; there was 300 cc serous fluid in abdomen and metastatic nodules with the largest diameter of 2-3 mm that were not protruding from surface were observed on all intestinal serosas and all peritoneal surfaces. The appearance of omentum was retracted and infiltrated at the site of hepatic flexura. The gallbladder was completely like a tumoral mass that was hard and had attached to the surrounding tissues. Both adnexial masses were examined at frozen section and the result was malignant. According to general surgery consultation; the primary tumor was gallbladder carcinoma. Hysterectomy, omentectomy and appendectomy were performed. Pathologic examination resulted as adenocarcinoma metastasizing to the myometrium, endometrium, ovaries, appendix and omentum. Metastatic genital organ carcinomas mistakenly may be diagnosed as primary genital carcinoma. Whenever the clinic presentation seems atypical, all the differential diagnoses must be considered and necessary examinations and tests must be performed.