Cytoreductive surgical treatment of giant metastasis of colorectal cancer in the ovary (clinical case)

Abstract

Purpose - to present and analyze the case of surgical treatment of a patient with secondary giant adenocarcinoma of the right ovary.

It is presented a clinical case of a giant metastasis of colorectal cancer to the ovary in a 48-year-old woman, measuring 30×20×15 cm, weighing about 9 kg, which occupied almost the entire volume of the abdominal cavity, pushing the stomach and intestines under the diaphragm with compression of the intestines, right ureter and the presence of ascites with a volume of 1.5 liters. A right-sided hemicolectomy with lymphodissection was performed, and an end-to-end ileotransversoanastmosis was applied. A right adnexectomy, extirpation of the uterus, omentectomy were performed.

During the immunohistochemical study, membrane-cytoplasmic expression of cytokeratin (CK) 20 and nuclear expression of CDX2 were revealed. CDX2 is a defining marker for the diagnosis of adenocarcinoma of the gastrointestinal tract, as well as for the differentiation of primary and metastatic ovarian carcinomas. The patient has a lack of expression of receptors for estrogen and CK7 and positive nuclear expression of CDX2, which indicates metastasis of colorectal adenocarcinoma to the ovary. According to the results of the histological examination, which were of decisive importance, the origin of the tumor was determined and, accordingly, the patient’s diagnosis - the tumor of the cecum is G2 adenocarcinoma with germination into the serous membrane, metastases to the right ovary and regional lymphatic nodes 10 out of 10, and areas of tumor growth in the mesentery.

Conclusions. In the case of detection of an ovarian neoplasm, the differential diagnosis of primary and secondary tumors is extremely important. Reproductive age at the time of presentation should not interfere with the diagnosis of primary or secondary ovarian malignancy. Metastases of primary colorectal cancer in the ovaries can manifest as pelvic tumors, so preoperative examination of the gastrointestinal tract and removal of the ovarian tumor with immunohistochemical examination is the leading option for choosing an appropriate treatment strategy. Immunohistochemical study of cytokeratin expression markers CK7, CK20 are appropriate for the differential diagnosis of synchronous cancer of the cecum and ovary, and CDX2 protein is a defining marker for the diagnosis of adenocarcinoma of the gastrointestinal tract and for distinguishing between primary and metastatic ovarian carcinomas. Cytoreductive surgery appears to be an important treatment option for metastatic ovarian neoplasia to improve prognosis. A multidisciplinary approach remains key in further examination, determination of the main diagnosis and development of an optimal treatment strategy.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.