ISOLATED PRESACRAL LOW-GRADE ENDOMETRIOID OVARIAN CARCINOMA – A RECURRENCE CASE

Abstract

Ovarian cancer, primarily epithelial ovarian carcinomas (EOCs), is a leading cause of gynecological cancer mortality. Among EOCs, low-grade endometrioid ovarian carcinoma (LG-EOC) accounts for 10–15% of cases, characterized by a favorable prognosis but significant potential for recurrence. This case discusses a 44-year-old female with recurrent isolated presacral LG-EOC managed with secondary cytoreductive surgery. Diagnosed in 2021, she presented with a multiloculated cystic lesion on surveillance imaging, later confirmed by MRI and PET-CT to exhibit hypermetabolic activity suggestive of recurrence. She underwent successful secondary cytoreductive surgery, achieving optimal debulking without residual disease. Histopathology confirmed low-grade endometrioid carcinoma, and immunohistochemistry showed intact nuclear expression of mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, PMS2), ruling out microsatellite instability-high (MSI-H). This result excluded Lynch syndrome and suggested a competent DNA repair system, influencing her management and prognosis. The patient’s postoperative course was uneventful, and she was discharged with instructions for follow-up and genetic counseling. This case highlights the role of meticulous surgical management and histopathological evaluation in recurrent LG-EOC. It also underscores the importance of individualized approaches, particularly in assessing molecular markers like MMR proteins, which guide therapeutic decisions and genetic risk evaluation. Secondary cytoreduction remains crucial for improving survival in recurrent ovarian cancer.