Okamura Shu, Noda Hozumi, Ohishi Kazuhito, Kitahara Tomohiro, Murata Kohei, Minoji Takayuki, Hamano Rie, Yanagisawa Tetsu, Fukuchi Nariaki, Ebisui Chikara, Yokouchi Hideoki, Nishizaki Takamichi, Kinuta Masakatsu
Dept. of Surgery, Suita Municipal Hospital.
Gan To Kagaku Ryoho. 2017 Nov;44(12):1714-1716.
We here report the case of a 56-year-old female patient who underwent curative resection for right ovarian cancer with intraperitoneal dissemination and liver metastases. She received following adjuvant chemotherapy, and had been visited hospital for regular follow-up since then. One and half a year after surgery, blood examination showed increasing value of CA125. Contrast-enhanced CT scan revealed a tumor whose long diameter was 5 cm at front side of lower rectum. Following MRI and PET-CT examinations indicated the pelvic tumor as recurrence of ovarian cancer, so that laparotomy was carried out. As the tumor was palped through Douglas cavum, we performed low-anterior rectal resection for en bloc tumor extirpation. Tumor cells mainly developed at peri-rectal wall and proper muscle by HE staining of pathological findings, and ER(positive), vimentin(positive), CD56(positive), synaptophysin(negative)and chromogranin A(negative)by immunostaining indicated the tumor as metastasis of ovarian cancer. Though rectal metastasis from ovarian cancer is basically rare, it might be necessary to rule out possibility of metastatic colon tumor from ovarian cancer when treating patient with rectal tumor who had underwent surgery for ovarian cancer before.
我们在此报告一例56岁女性患者，她因右卵巢癌伴腹膜播散和肝转移接受了根治性切除术。她接受了后续辅助化疗，此后一直在医院定期随访。术后一年半，血液检查显示CA125值升高。增强CT扫描显示在直肠下段前方有一个长径为5 cm的肿瘤。随后的MRI和PET-CT检查表明盆腔肿瘤为卵巢癌复发，因此进行了剖腹手术。由于在Douglas腔可触及肿瘤，我们进行了低位前直肠切除术以整块切除肿瘤。病理检查结果显示，HE染色下肿瘤细胞主要在直肠壁周围和固有肌层生长，免疫染色显示ER（阳性）、波形蛋白（阳性）、CD56（阳性）、突触素（阴性）和嗜铬粒蛋白A（阴性），表明该肿瘤为卵巢癌转移。虽然卵巢癌直肠转移基本罕见，但在治疗既往有卵巢癌手术史的直肠肿瘤患者时，可能有必要排除卵巢癌转移至结肠肿瘤的可能性。
