Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan.
BMC Surg. 2022 Mar 23;22(1):111. doi: 10.1186/s12893-022-01565-4.
Patients with giant ovarian tumor often have severe symptoms, such as abdominal distention, and the tumor tends to grow rapidly; therefore, sufficient preoperative assessments are difficult to perform. It is not always easy to differentiate between primary and metastatic ovarian cancer, especially when the ovarian tumor is huge, since a precise diagnosis of ovarian tumor depends on the histopathological findings of the excised specimen. Although metastatic ovarian tumors account for over 20% of all malignant ovarian tumors, preoperative colonoscopy is not considered a routine examination before surgery for giant ovarian tumor.
We herein report 3 cases of giant (> 25 cm) ovarian tumor with colorectal cancer. All three patients visited the clinic with progressing abdominal distention, and were referred with primary ovarian malignancy. Case 1: Rectal tumor was suspected by a digital examination at the outpatient clinic, and rectal cancer was diagnosed preoperatively by colonoscopy. Computed tomography revealed a single-nodule liver tumor. Ovariectomy, rectal resection, and partial hepatectomy were performed. A histological examination revealed both primary mucinous ovarian carcinoma and rectal carcinoma with liver metastasis. Case 2: Initially, the ovarian tumor was diagnosed as primary carcinoma based on the histological findings of an incision biopsy at the previous hospital. Chemotherapy for ovarian cancer was administered without remission, and subsequently, the patient was referred to our hospital. Since the CEA level was high (142 ng/ml), colonoscopy was performed and cecal cancer was diagnosed. Ovariectomy and right colectomy were performed, and the ovarian tumor was histologically diagnosed as metastatic adenocarcinoma. Case 3: Initial ovariectomy was performed, and rectal cancer was suspected at intra-operative surveillance. Colonoscopy was performed after surgery, and rectal cancer was diagnosed. The ovarian tumor was diagnosed as metastatic adenocarcinoma. After six cycles of FOLFOX, rectal resection was performed.
Regrettably, two of three cases in the current series were not diagnosed with colorectal cancer at the start of treatment. This experience suggests that screening colonoscopy should be considered before treatment for every case of giant ovarian tumor.
患有巨大卵巢肿瘤的患者通常有严重的症状，如腹胀，并且肿瘤往往生长迅速；因此，很难进行充分的术前评估。原发性和转移性卵巢癌之间的鉴别并不总是容易的，尤其是当卵巢肿瘤巨大时，因为卵巢肿瘤的准确诊断取决于切除标本的组织病理学发现。尽管转移性卵巢肿瘤占所有恶性卵巢肿瘤的 20%以上，但对于巨大卵巢肿瘤，术前结肠镜检查并不是手术前的常规检查。
我们在此报告 3 例 (>25cm) 巨大卵巢肿瘤合并结直肠癌病例。所有 3 例患者均因进行性腹胀就诊，并被转诊为原发性卵巢恶性肿瘤。病例 1：在门诊进行直肠指检时怀疑直肠有肿瘤，术前结肠镜检查诊断为直肠癌。计算机断层扫描显示单个肝结节肿瘤。进行了卵巢切除术、直肠切除术和部分肝切除术。组织学检查显示原发性黏液性卵巢癌和直肠伴肝转移癌。病例 2：最初，根据前一家医院的切口活检组织学结果，该卵巢肿瘤被诊断为原发性癌。卵巢癌化疗无效，随后患者被转诊至我们医院。由于 CEA 水平升高（142ng/ml），进行了结肠镜检查并诊断为盲肠癌。进行了卵巢切除术和右结肠切除术，卵巢肿瘤的组织学诊断为转移性腺癌。病例 3：最初进行了卵巢切除术，术中监测怀疑为直肠癌。术后进行了结肠镜检查，诊断为直肠癌。卵巢肿瘤被诊断为转移性腺癌。完成六周期 FOLFOX 后，进行了直肠切除术。
遗憾的是，本系列中有 2 例在开始治疗时未被诊断为结直肠癌。这一经验表明，对于每一例巨大卵巢肿瘤，在治疗前都应考虑进行筛查性结肠镜检查。
