Synchronous ovarian metastasis from colorectal cancer: A report of two cases

Abstract

Abstract. Ovarian metastasis of colorectal cancer is relatively rare. The present study reports two cases of synchronous ovarian metastasis from colorectal cancer, which were managed by cytoreductive surgery. In case one, a 60-year-old female patient presented with a multilocular pelvic tumor and ascites. Virtual colonoscopy revealed a mass in the sigmoid colon; however, no tumor cells were identified on histological examination. Ovarian metastasis from sigmoid colon cancer was suspected and adnexectomy was subsequently performed. Histological examination of the excised tumor revealed adenocarcinoma. Immunohistochemical analysis of the resected tumor revealed positive staining for cytokeratin (CK)20 and caudal-type homeobox 2 (CDX2), and negative staining for CK7, estrogen receptor, progesterone receptor and inhibin. The immunohistological results supported the diagnosis of ovarian metastasis from sigmoid colon cancer. In case two, a 56-year-old female patient presented with a multilocular pelvic tumor and ascites. Colonoscopy identified a rectal tumor, and histological examination revealed moderately-differentiated adenocarcinoma, which was confirmed by cytological analysis of ascites. Subsequently, ovarian metastasis from rectal cancer with peritoneal dissemination was diagnosed, and left ovariectomy and transverse colostomy were performed. Histological examination of the excised tumor revealed moderately-differentiated adenocarcinoma, and immunohistochemical investigation revealed positive staining for CK20 and CDX2, but negative staining for CK7. These immunohistological results indicated ovarian metastasis from rectal cancer. Both patients recovered well and are currently undergoing regular follow-up examinations. The observations from the two cases indicate that ovarian metastases of primary colorectal cancer may present as pelvic tumors and, thus, preoperative examination of the gastrointestinal tract is required. Furthermore, even in cases of widespread colorectal cancer metastases, excision of the ovarian tumor is required to establish a histological diagnosis for the selection of appropriate treatments. IntroductionCommon sites for synchronous metastases from colorectal cancer include the liver, lung, peritoneum, bone and brain (1). The frequency of ovarian metastasis from colorectal cancer is 1.6-6.4%, however, this type of metastasis is difficult to distinguish from primary ovarian neoplasms (2-5). Furthermore, synchronous ovarian metastasis from colorectal cancer is generally poor, and the optimal first-line treatment strategy is debatable (6,7). The present study reports two cases of synchronous ovarian metastasis from colorectal cancer that were managed by cytoreductive surgery. Case reportCase one. A 60-year-old female patient presented to Katsuta Hospital (Katsuta, Japan) in June 2014 with progressive abdominal distension and lower abdominal pain. The following day the patient was referred to Ibaraki Medical Center, Tokyo Medical University (Ami, Japan) with a suspected diagnosis of pelvic tumor...

Synchronized Bilateral Giant Krukenberg Tumor Originating from the Colon

“…7 In ovarian mucinous tumours, CK7 is typically positive whereas CK20 displays variable positivitywhereas metastatic gastrointestinal carcinoma is CK7 negative and CK20 positive. 3,8,9 Radiologically, KTs typically appear as bilateral, irregular, hyperechoic solid pattern with well-defined cystic areas producing a prominent vascular signal along the cystic wall. CT scans show solid ovarian masses with strong contrast enhancing walls which are absent in primary ovarian cancer as in our case.…”

Ovarian Metastasis from Colorectal Adenocarcinoma

“…Ovarian metastasis from colorectal cancer usually presents as a palpable abdominal mass. 2,8 Reports indicate that between 3% and 20.9% of women with colon and rectal carcinoma, an ovarian mass was observed before the suspicion of intestinal disease. 5,6 In our small series of cases, an increase in abdominal volume combined with a palpable mass was the main clinical presentation, with the development of these lesions always occurring during the follow-up period of the primary lesion.…”

“…The most reported symptoms include pain or discomfort in the abdomen, 2,6,7,9 in addition to progressive abdominal distention 2 and cramps. 8 Ascites is a frequent finding upon physical examination, 2,10 with an increase in abdominal circumference observed in approximately 63% of the…”

“…1 It represents a disease with a reserved prognosis due to malignant dissemination in the abdominal cavity associated with its origin, turning it essential to evaluate treatment alternatives that can improve the survival of the patients, such as cytoreductive surgery. 1,2 The differential diagnosis between primary and metastatic ovarian tumors is quite difficult, 2,4 requiring knowledge of specific clinical features in addition to other diagnostic techniques, such as histopathological evaluation, 5 immunohistochemistry, 2 and tumor marker values such as carcinoembryonic antigen (CEA) and cancer antigen 125 (CA-125). 6…”

Gone but Not Forgotten: Ovarian Metastasis From a Colon Carcinoma in a 19-Year-Old Female

“…In a plethora of cases, the patient may have a history of the primary tumor; however, in a majority of the cases, the patients may present with vague, non-specific symptoms, such as pain or abdominal distention, elicited by an ovarian mass [6]. In such instances, secondary ovarian tumors are erroneously diagnosed as primary ovarian cancers due to the remarkable resemblance in histopathological features of the metastatic and primary tumors, resulting in diagnostic misinterpretation, ineffective management, and thus portending a worse prognosis [7]. The metastatic spread of colon carcinoma to the ovaries, due to its ambiguous mode of spread and tumor behavior, therefore poses a perplexing diagnostic dilemma for the clinicians.…”