Transvaginal ultrasound showed a complex solid cystic lesion measuring 6.9cm x 5.3cm with the fatty component within the left adnexa and a 3.3cm x 2cm heteroechoic well-defined lesion arising from the posterior wall of the body of uterus likely fibroid with normal endometrial thickness. CT scan of the abdomen and pelvis revealed approximately 7.1cm x 4.8cm x 4.5cm well defined heterogeneous solid cystic lesion in the left adnexa. The solid components showed heterogeneous enhancement in post-contrast images. Medially the mass was abutting the urinary bladder wall, laterally it was abutting the common iliac vessel and superiorly the bowel loops. The uterus was bulky measuring approx 9.6cm x 5.2cm with mild heterogeneous collection noted in the endometrial cavity. (Figure 1) All the features were suggestive of left ovarian neoplasm. Endometrial biopsy was also done which showed atypical endometrial hyperplasia.

After the positive frozen section pathological examination in the ovaries, the patient underwent total abdominal hysterectomy with bilateral salphingo-oophorectomy with bilateral pelvic and para-aortic lymphadenectomy, omentectomy, appendectomy, and peritoneal biopsies. (Figure 2) Intraoperatively, there was an irregular mass of around 6cm x 6cm arising from the left ovary. Cross-section of ovary revealed fatty material and cheesy material inside. There was no internal septation or papillary projection. The uterus was 10cm with body and cervix 7cm and 3cm respectively with a rough towel appearance. Myometrial thickness was 3 cm with endometrial hyperplasia noted. The endocervical canal was empty. (Figure 3) Her post-operative period was unremarkable and was discharged on the 4^th postoperative day.

Histopathology of the excised specimens revealed endometrioid endometrial carcinoma and left ovarian endometroid carcinoma with histological grade 2. The tumor was limited to the inner half of the myometrium and 5mm within the capsule of the ovary. Lymphovascular invasion was not seen. (Figure 4 and 5) Peritoneal cytological washing and biopsies, as well as lymph nodes, were negative for malignant cells. The final diagnosis of synchronous FIGO Ia endometroid endometrial carcinoma and FIGO Ia endometroid ovarian carcinoma was made. The patient is disease-free at nine months of follow-up with no evidence of recurrence.