273 Bilateral Ovarian Involvement by Metastatic Endocervical Adenocarcinoma: A Diagnostic Case Highlighting Delayed Metastasis and Histopathologic Confirmation in a Patient with Refractory Thromboembolic Disease

Introduction/Objective Ovarian involvement by metastatic endocervical adenocarcinoma is an uncommon occurrence, particularly when bilateral, and poses diagnostic challenges, especially in the context of limited therapeutic options and complicating comorbidities such as recurrent thromboembolism. Methods/Case Report A 46-year-old woman with FIGO stage IB1 endocervical adenocarcinoma underwent radical hysterectomy and left oophorectomy for recurrence in 2019. She declined adjuvant therapy. Her course was complicated by recurrent venous thromboembolism, requiring IVC filter placement. In early 2025, she presented with abdominal pain. Imaging revealed a right adnexal mass and ascites. Right oophorectomy and omentectomy were performed. Histology showed cribriform glandular architecture. Cells show loss of polarity and nuclear overlapping with brisk mitotic activity. Immunohistochemistry revealed diffuse p16 positivity, weak ER expression, and negative CDX-2. p53 showed a wild-type pattern. High-risk HPV RNA in situ hybridization was positive. Findings confirmed metastatic endocervical adenocarcinoma, establishing asynchronous bilateral ovarian metastasis six years after initial ovarian involvement. Results NA Conclusion This case underscores the importance of detailed histopathologic and molecular evaluation in distinguishing metastatic from primary ovarian tumors. The prolonged interval between ovarian involvements emphasizes the potential for delayed metastatic spread and the necessity for long-term vigilance in patients with a history of HPV-associated cervical neoplasia.