Shigeyoshi Itaru, Komori Koji, Kinoshita Takashi, Oshiro Taihei, Ito Seiji, Abe Tetsuya, Senda Yoshiki, Misawa Kazunari, Ito Yuichi, Uemura Norihisa, Natsume Seiji, Kawakami Jiro, Ouchi Akira, Tsutsuyama Masayuki, Hosoi Takahiro, Akazawa Tomoyuki, Hayashi Daisuke, Tanaka Hideharu, Yatabe Yasushi, Shimizu Yasuhiro
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Aichi, Japan.
Nagoya J Med Sci. 2017 Feb;79(2):259-266. doi: 10.18999/nagjms.79.2.259.
Metachronous ovarian metastasis of colorectal adenocarcinoma is mostly identified within 3 years. Here we present a case of a 64-year-old woman with cecal cancer who underwent right oophorectomy for ovarian metastasis. Imaging was performed because of abdominal bloating; it detected a swollen right ovary with ascites. On laparotomy, a right ovarian tumor and cecal cancer were identified. After right oophorectomy, a diagnosis of unilateral ovarian metastasis from colon cancer was made. One month later, right hemicolectomy was performed. Eight years after initial surgery, the patient presented with vaginal bleeding. A computed tomography (CT) scan revealed a pelvic mass approximately 10 cm in diameter, but no mass was evident on a CT image taken 6 months before. The patient was diagnosed with left ovarian metastasis from colon cancer. A third laparotomy revealed a left ovarian tumor, but there was no evidence of other metastases or peritoneal dissemination. Left oophorectomy was performed. Oophorectomy is considered to be associated with a survival benefit in ovarian metastasis without other extensive metastasis. However, ovarian metastasis is often bilateral. Although complete resection was achieved in the present case, the findings support performing prophylactic bilateral oophorectomy if metastasis is identified in a unilateral ovary.
结直肠癌的异时性卵巢转移大多在3年内被发现。在此,我们报告一例64岁患有盲肠癌的女性患者,因卵巢转移接受了右侧卵巢切除术。因腹胀进行了影像学检查;检查发现右侧卵巢肿大并伴有腹水。剖腹手术时,发现了右侧卵巢肿瘤和盲肠癌。右侧卵巢切除术后,诊断为结肠癌单侧卵巢转移。1个月后,进行了右半结肠切除术。初次手术后8年,患者出现阴道出血。计算机断层扫描(CT)显示盆腔有一个直径约10厘米的肿块,但6个月前的CT图像上未发现肿块。患者被诊断为结肠癌左侧卵巢转移。第三次剖腹手术发现左侧卵巢肿瘤,但没有其他转移或腹膜播散的证据。进行了左侧卵巢切除术。对于无其他广泛转移的卵巢转移患者,卵巢切除术被认为与生存获益相关。然而,卵巢转移往往是双侧的。尽管本例实现了完全切除,但这些发现支持在单侧卵巢发现转移时进行预防性双侧卵巢切除术。