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

Shimazaki,Jiro; Tabuchi,Takanobu; Nishida,Kiyotaka; Takemura,Akira; Motohashi,Gyo; Kajiyama,Hideki; Suzuki,Shuji

doi:10.3892/ol.2016.4553

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

Authors:
- Jiro Shimazaki
- Takanobu Tabuchi
- Kiyotaka Nishida
- Akira Takemura
- Gyo Motohashi
- Hideki Kajiyama
- Shuji Suzuki
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Affiliations: Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300‑0395, Japan
Published online on: May 11, 2016 https://doi.org/10.3892/ol.2016.4553
Pages: 257-261

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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.

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1	Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, et al: Japanese Society for Cancer of the Colon and Rectum: Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 17:1–29. 2012. View Article : Google Scholar : PubMed/NCBI
2	Lee KR and Young RH: The distinction between primary and metastatic mucinous carcinomas of the ovary: Gross and histologic findings in 50 cases. Am J Surg Pathol. 27:281–292. 2003. View Article : Google Scholar : PubMed/NCBI
3	Shiono S, Saito T, Fujii H, Arakawa A, Nakamura T and Yao T: A case of Krukenberg carcinoma metastasized from colon cancer resembling mucinous cystadenocarcinoma of the ovary. Int J Clin Exp Pathol. 7:394–401. 2013.PubMed/NCBI
4	Aiyer R, Sweetman K, Larsen-Disney P and Fish A: A colorectal carcinoma imitating a primary ovarian carcinoma in a postpartum woman. BMJ Case Rep. 2013:pii: bcr2013201055. 2013.PubMed/NCBI
5	Hata T, Yoshioka S, Asukai K, Mizumoto S, Nakanishi M, Hamano R, Maekawa T, Hama N, Kashiwazaki M, Taniguchi M, et al: Two cases of ovarian metastasis of colon cancer. Gan To Kagaku Ryoho. 38:2286–2288. 2011.(In Japanese). PubMed/NCBI
6	Chung TS, Chang HJ, Jung KH, Park SY, Lim SB, Choi HS and Jeong SY: Role of surgery in the treatment of ovarian metastases from colorectal cancer. J Surg Oncol. 100:570–574. 2009. View Article : Google Scholar : PubMed/NCBI
7	Rayson D, Bouttell E, Whiston F and Stitt L: Outcome after ovarian/adnexal metastectomy in metastatic colorectal carcinoma. J Surg Oncol. 75:186–192. 2000. View Article : Google Scholar : PubMed/NCBI
8	Ayhan A, Tuncer ZS and Bükülmez O: Malignant tumors metastatic to the ovaries. J Surg Oncol. 60:268–276. 1995. View Article : Google Scholar : PubMed/NCBI
9	Graffner HO, Alm PO and Oscarson JE: Prophylactic oophorectomy in colorectal carcinoma. Am J Surg. 146:233–235. 1983. View Article : Google Scholar : PubMed/NCBI
10	MacKeigan JM and Ferguson JA: Prophylactic oophorectomy and colorectal cancer in premenopausal patients. Dis Colon Rectum. 22:401–405. 1979. View Article : Google Scholar : PubMed/NCBI
11	Birnkrant A, Sampson J and Sugarbaker PH: Ovarian metastasis from colorectal cancer. Dis Colon Rectum. 29:767–771. 1986. View Article : Google Scholar : PubMed/NCBI
12	Cho KC and Gold BM: Computed tomography of Krukenberg tumors. AJR Am J Roentgenol. 145:285–288. 1985. View Article : Google Scholar : PubMed/NCBI
13	Wauters CC, Smedts F, Gerrits LG, Bosman FT and Ramaekers FC: Keratins 7 and 20 as diagnostic markers of carcinomas metastatic to the ovary. Hum Pathol. 26:852–855. 1995. View Article : Google Scholar : PubMed/NCBI
14	Berezowski K, Stastny JF and Kornstein MJ: Cytokeratins 7 and 20 and carcinoembryonic antigen in ovarian and colonic carcinoma. Mod Pathol. 9:426–429. 1996.PubMed/NCBI
15	German MS, Wang J, Fernald AA, Espinosa R III, Le Beau MM and Bell GI: Localization of the genes encoding two transcription factors, LMX1 and CDX3, regulating insulin gene expression to human chromosomes 1 and 13. Genomics. 24:403–404. 1994. View Article : Google Scholar : PubMed/NCBI
16	Mutoh H, Sakurai S, Satoh K, Tamada K, Kita H, Osawa H, Tomiyama T, Sato Y, Yamamoto H, Isoda N, et al: Development of gastric carcinoma from intestinal metaplasia in Cdx2-trasgenic mice. Cancer Res. 64:7740–7747. 2004. View Article : Google Scholar : PubMed/NCBI
17	Li MK and Folpe AL: CDX-2, a new marker for adenocarcinoma of gastrointestinal origin. Adv Anat Pathol. 11:101–105. 2004. View Article : Google Scholar : PubMed/NCBI
18	Guo RJ, Suh ER and Lynch JP: The role of Cdx proteins in intestinal development and cancer. Cancer Biol Ther. 3:593–601. 2004. View Article : Google Scholar : PubMed/NCBI
19	Kato R, Murata K, Okamura S, Wada Y, Makino S, Nishigaki T, Owada Y, Murakami M, Okada K, Ebisui C, et al: Resection of ovarian metastasis of colon cancer to improve quality of life. Gan To Kagaku Ryoho. 39:2278–2279. 2012.(In Japanese). PubMed/NCBI
20	McCormick CC, Giuntoli RL II, Gardner GJ, Schulick RD, Judson K, Ronnett BM, Vang R and Bristow RE: The role of cytoreductive surgery for colon cancer metastatic to the ovary. Gynecol Oncol. 105:791–795. 2007. View Article : Google Scholar : PubMed/NCBI
21	Jiang R, Tang J, Cheng X and Zang RY: Surgical treatment for patients with different origins of Krukenberg tumors: Outcomes and prognostic factors. Eur J Surg Oncol. 35:92–97. 2009. View Article : Google Scholar : PubMed/NCBI
22	Saltz LB, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, Koski S, Lichinitser M, Yang TS, Rivera F, et al: Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: A randomized phase III study. J Clin Oncol. 26:2013–2019. 2008. View Article : Google Scholar : PubMed/NCBI
23	Fuchs CS, Marshall J and Barrueco J: Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: Updated results from the BICC-C study. J Clin Oncol. 26:689–690. 2008. View Article : Google Scholar : PubMed/NCBI
24	Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, Humblet Y, Bodoky G, Cunningham D, Jassem J, et al: Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: The PRIME study. J Clin Oncol. 28:4697–4705. 2010. View Article : Google Scholar : PubMed/NCBI
25	Köhne CH, Hofheinz R, Mineur L, Letocha H, Greil R, Thaler J, Fernebro E, Gamelin E, Decosta L and Karthaus M: First-line panitumumab plus irinotecan/5-fluorouracil/leucovorin treatment in patients with metastatic colorectal cancer. J Cancer Res Clin Oncol. 138:65–72. 2012. View Article : Google Scholar : PubMed/NCBI