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.
Common sites for synchronous metastases from colorectal cancer include the liver, lung, peritoneum, bone and brain (
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. The patient's medical history was otherwise unremarkable. Physical examination revealed lower abdominal tenderness with a palpable mass. Laboratory data revealed slight hypoalbuminemia (albumin, 3.5 g/dl; normal range, >4.0 g/dl), and carcinoembryonic antigen (CEA; 11.1 ng/ml; normal range, <5.0 ng/ml) and carbohydrate antigen (CA) 125 (743.7 U/ml; normal range, <37.0 U/ml) levels were increased. Abdominal computed tomography (CT; Somatom Sensation Cardiac; Siemens, AG, Munich, Germany) revealed a multilocular cystic pelvic mass with a solid component measuring 17 cm in diameter and an irregular mass located in the sigmoid colon (
A 56-year-old female patient presented to Ryugasaki Saiseikai Hospital (Ryugasaki, Japan) in September 2014 with progressive abdominal distension. The following day the patient was referred to Ibaraki Medical Center, Tokyo Medical University, with a suspected ovarian tumor. The patient's medical history was otherwise unremarkable. Physical examination revealed abdominal distention with fluctuation, indicating abundant ascites. Laboratory data revealed increased lactate dehydrogenase (2,473 IU/l, normal range, 120–240 IU/l), CEA (93.9 ng/ml) and CA 125 (274.4 U/ml) levels. Abdominal CT (Somatom Sensation Cardiac) revealed a multilocular cystic pelvic mass with a solid component, measuring 12 cm in diameter, and ascites (
Metastatic ovarian tumors account for ~21.5% of all malignant ovarian tumors and 3.7–7.4% of the cases metastasize from colorectal cancer (
The optimal first-line treatment strategy for synchronous ovarian metastasis from colorectal cancer remains controversial. The Japanese guidelines for colorectal cancer treatment recommend surgery for metastatic lesions if the primary colorectal and metastatic lesions are completely resectable, and if the patient is able to tolerate resection of the metastatic lesions (
In conclusion, ovarian metastases from primary colorectal cancer may present as pelvic tumors, thus, preoperative examination of the gastrointestinal tract and excision of the ovarian tumor are required to establish a histological diagnosis for the selection of appropriate treatment strategies.
The authors would like to thank Enago (
Case one. Abdominal enhanced computed tomography demonstrating (A) a multilocular cystic mass in the pelvic space and (B) an irregular mass located in the sigmoid colon (arrow).
Case one. Virtual colonoscopy revealing stenosis with a mass in the sigmoid colon (arrow).
Case one. Macroscopic examination and histological analysis of the excised tumor specimen. (A) A multilocular cystic tumor, measuring 17×14×8 cm with multicystic walls and septa, containing solid and necrotic components was identified. (B) Histological staining revealing moderately-differentiated adenocarcinoma forming in the septa with infiltration of the cystic wall (stain, hematoxylin and eosin; magnification, ×100).
Case one. Immunohistochemical staining of the excised tumor revealed positive staining for (A) cytokeratin (CK)20 and (B) caudal-type homeobox 2, and negative staining for (C) CK7, (D) estrogen receptor, (E) progesterone receptor and (F) inhibin (magnification, ×100).
Case two. Abdominal enhanced computed tomography demonstrating a multilocular cystic mass and ascites in the pelvic space.
Case two. Macroscopic examination of the excised specimen revealing a multilocular cystic tumor measuring 12×11×8 cm, with multicystic walls and septa, composed of solid and necrotic components.
Case two. (A) Histological analysis of the excised tumor revealing moderately-differentiated adenocarcinoma forming in the cystic walls and septa (stain, hematoxylin and eosin; magnification, ×100). Immunohistochemical staining of the excised tumor revealing positive staining for (B) cytokeratin 20 and (C) caudal-type homeobox 2 and (D) negative staining for CK7.