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Problems in Colon Cancer and a Child With Renal Lymphoma

CASE 1. Metastatic Colon Cancer to the Ovaries in a Krukenberg-Like Pattern

Departments of Medicine, Surgery, and Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY

A 47-year-old woman with a 1-year history of moderately differentiated adenocarcinoma of the ascending colon (T3N2M0) developed metastatic nodal and peritoneal disease, despite primary resection and adjuvant treatment with fluorouracil and leucovorin. After progression of disease on irinotecan chemotherapy, she had an excellent response to oxaliplatin and fluorouracil (FOLFOX6), except within the left lower quadrant. A computed tomography scan of the chest, abdomen, and pelvis was significant for a 21.0 x 16.0-cm multicystic left adnexal mass filling a substantial portion of the left hemiabdomen (Fig 1). The patient underwent palliative bilateral salpingo-oophorectomy when lower abdominal pain compromised her quality of life. At the time of surgery, intra-abdominal contents were free of disease, except for a 26.5 x 18-cm left ovarian mass and a smaller right ovarian mass, the former of which was divided from the infundibulopelvic ligament and fallopian tube and resected without difficulty (Fig 2). Pathology tests confirmed CK20-positive adenocarcinoma of the colon, metastatic to bilateral ovaries (Fig 3). The patient was discharged on postoperative day 4. She is being followed expectantly and has no evidence of disease.

View larger version (102K): [in this window] [in a new window]   Fig 1.

View larger version (87K): [in this window] [in a new window]   Fig 2.

View larger version (121K): [in this window] [in a new window]   Fig 3.

Ovarian metastases are typically solid bilateral masses, and develop in approximately 1% to 2% of women with primary intestinal cancers.^3,4 Krukenberg tumors represent 30% to 40% of metastases to the ovary, and approximately 5% of all ovarian neoplasms.^4-7 Although the primary site of the metastatic tumor is classically gastric cancer, primary sites such as colon, breast, and biliary tract have been reported. The diagnosis of a primary gastrointestinal malignancy predates development of ovarian metastases in more than 25% of patients.⁸ In most other patients, the primary malignancy is identified at the time of oophorectomy or during the postoperative period.

In our experience, ovarian metastases show less chemotherapy responsiveness than other sites of metastasis. Independent of chemotherapy sensitivity, patients with this pattern of metastasis may fare worse than patients with other sites of metastatic disease. Five-year overall survival after resection of Krukenberg tumors is 19%, in contrast to 5-year overall survival for resected liver metastases from colorectal carcinoma of 37% in one large series.^9,10 Krukenberg tumors should be distinguished from primary ovarian neoplasms, such as primary mucinous adenocarcinoma of the ovary, or the benign signet cell stromal tumor of the ovary, since management of these clinical situations is so different.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

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2. Schlagenhaufer F: Ueber das metastatische ovarialcarcinom nach krebs des magens, darmes und anderer bauchorgane. Monatshr Gerburtsh Gynak 15:485, 1902

3. Yakushiji M, Tazaki T, Nishimura H, et al: Krukenberg tumors of the ovary: A clinicopathologic analysis of 112 cases. Nippon Sanka Fujinka Gakkai Zasshi 39:479-485, 1987[Medline]

4. McGill F, Ritter DB, Rickard C, et al: Management of Krukenberg tumors: An 11-year experience and review of the literature. Prim Care Update Ob Gyns 5:157-158, 1998

5. Mazur MT, Hsueh S, Gersell DJ: Metastases to the female genital tract: Analysis of 325 cases. Cancer 53:1978-1984, 1984[CrossRef][Medline]

6. Holtz F, Hart WR: Krukenberg tumors of the ovary: A clinicopathologic analysis of 27 cases. Cancer 50:2438-2447, 1982[CrossRef][Medline]

7. Woodruff JD, Novak ER: The Krukenberg tumor: Study of 48 cases from the ovarian tumor registry. Obstet Gynecol 15:351-360, 1960[Medline]

8. Webb MJ, Decker DG, Mussey E: Cancer metastatic to the ovary: Factors influencing survival. Obstet Gynecol 45:391-396, 1975[Medline]

9. Yada-Hashimoto N, Yamamoto T, Kamiura S, et al: Metastatic ovarian tumors: A review of 64 cases. Gynecol Oncol 89:314-317, 2003[CrossRef][Medline]

10. Fong Y, Fortner J, Sun RL, et al: Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: Analysis of 1001 consecutive cases. Ann Surg 230:309-318, 1999[CrossRef][Medline]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Traina, T. A. Articles by Maki, R. G. Search for Related Content PubMed PubMed Citation Articles by Traina, T. A. Articles by Maki, R. G. Social Bookmarking                            What's this?