Uenae Maika, Sasano Tomoyuki, Tomiie Mari, Miyagi Yoshimi, Moriyama Akihiro
Department of Obstetrics and Gynecology, Osaka Saiseikai Nakatsu Hospital, Osaka, JPN.
Department of Pathology, Osaka Saiseikai Nakatsu Hospital, Osaka, JPN.
Cureus. 2025 Apr 2;17(4):e81626. doi: 10.7759/cureus.81626. eCollection 2025 Apr.
Metastasis of colorectal cancer (CRC) to the ovaries is relatively rare, and torsion of metastatic ovarian tumors is even rarer. Here, we report the case of a patient with CRC who developed torsion of ovarian metastases and underwent abdominal adnexectomy following chemotherapy with bevacizumab. A 51-year-old premenopausal woman presented with abdominal distension and was referred to our hospital after ultrasonography revealed abdominal tumors. Imaging showed bilateral ovarian masses (maximum diameters: right, 10 cm; left, 14 cm), subserosal leiomyomas, and a circumferential sigmoid colon tumor with peritoneal nodules and ascites. A colonoscopy confirmed moderately differentiated adenocarcinoma. The patient was diagnosed with stage IV sigmoid colon cancer, including ovarian metastasis, peritoneal metastases, and pleural effusion. The patient began chemotherapy with tegafur, gimeracil, oteracil potassium, oxaliplatin, and bevacizumab, resulting in a decrease in carbohydrate antigen 19-9 levels, though carcinoembryonic antigen levels increased. After the fourth chemotherapy cycle, the patient experienced sudden left-sided abdominal pain accompanied by nausea. Computed tomography revealed torsion of the left ovarian tumor (maximum diameter: 19 cm) with suspected hemorrhage. A drop in hemoglobin levels required a blood transfusion. Emergency laparotomy revealed a three-turn torsion of the left ovarian pedicle and an intra-tumoral hemorrhage. A bilateral adnexectomy was performed, and ovarian metastases from colon cancer were confirmed pathologically. Despite bevacizumab treatment, the patient's postoperative course was uneventful, and she was discharged on day 12. Chemotherapy was resumed. In patients with metastatic ovarian tumors who present with sudden abdominal pain, ovarian torsion should be considered in the differential diagnosis, even in the context of malignancy.
结直肠癌（CRC）转移至卵巢相对少见，而转移性卵巢肿瘤发生扭转则更为罕见。在此，我们报告1例CRC患者发生卵巢转移瘤扭转，并在接受贝伐单抗化疗后行腹部附件切除术。一名51岁绝经前女性因腹胀就诊，超声检查发现腹部肿物后转诊至我院。影像学检查显示双侧卵巢肿物（最大直径：右侧10cm，左侧14cm）、浆膜下平滑肌瘤以及乙状结肠环形肿瘤伴腹膜结节和腹水。结肠镜检查确诊为中分化腺癌。该患者被诊断为IV期乙状结肠癌，包括卵巢转移、腹膜转移和胸腔积液。患者开始接受替加氟、吉美嘧啶、奥替拉西钾、奥沙利铂和贝伐单抗化疗，碳水化合物抗原19-9水平下降，不过癌胚抗原水平升高。在第四个化疗周期后，患者突然出现左侧腹痛伴恶心。计算机断层扫描显示左侧卵巢肿瘤（最大直径：19cm）扭转，疑似出血。血红蛋白水平下降需要输血。急诊剖腹探查发现左侧卵巢蒂扭转三圈并肿瘤内出血。行双侧附件切除术，病理证实为结肠癌卵巢转移。尽管接受了贝伐单抗治疗，患者术后恢复顺利，于第12天出院。随后继续化疗。对于出现突发腹痛的转移性卵巢肿瘤患者，即使在恶性肿瘤的情况下，鉴别诊断时也应考虑卵巢扭转。
