Endometrial adenokarsinom ile senkron paraaortik lenf nodunda primeri bilinmeyen alt gastrointestinal sistem metastazı: vaka sunumu

Aim: To contribute to the literature in the case of lower gastrointestinal system (GIS) adenocarcinoma coexisting synchronously with endometrial adenocarcinoma, which diagnosed with lymph node metastasis without symptoms in the primary organ.Case presentation: A 75-year-old multigravid postmenopausal patient presented with abnormal uterine bleeding. Diagnostic and therapeutic endometrial curettage was performed. Histopathological evaluation revealed findings consistent with endometrial adenocarcinoma. Preoperative advanced radiological imaging was conducted, which demonstrated bowel wall thickening in the lower gastrointestinal tract and lymph node involvement in the para-aortic region. Subsequently, endoscopic and colonoscopic evaluations were performed, and biopsies were taken from the suspicious areas. No evidence of malignancy was found in these gastrointestinal biopsies. The patient was diagnosed with endometrial cancer with para-aortic lymph node metastasis and underwent surgical staging. Final pathology confirmed endometrial adenocarcinoma in the uterus, along with gastrointestinal-type metastasis in the para-aortic lymph node. Genetic testing for hereditary cancer syndromes revealed no detectable genetic mutations. As adjuvant treatment, the patient received brachytherapy for endometrial cancer. Multiple gastrointestinal screenings were repeated during the follow-up period. Since no primary gastrointestinal malignancy could be identified during the 12-month follow-up, no additional adjuvant treatment was planned for the gastrointestinal tract. The patient continues to be monitored, with no evidence of recurrence to date.Conclusion: In hereditary cancer syndromes, multiple synchronous (simultaneous) or metachronous (sequential) malignancies can develop across different organ systems. Lynch syndrome, the most well-known of these syndromes, is associated with a synchronous tumor incidence of approximately 17-30% at the time of diagnosis. In contrast, sporadic synchronous tumors that are not genetically inherited are much rarer. Para-aortic lymph node metastasis in colorectal cancer is observed in less than 2% of cases. However, the incidence of colorectal cancers diagnosed solely through lymph node metastasis without detectable primary organ involvement remains unknown.