Chang T C, Changchien C C, Tseng C W, Lai C H, Tseng C J, Lin S E, Wang C S, Huang K J, Chou H H, Ma Y Y, Hsueh S, Eng H L, Fan H A
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung Medical College, Taoyuan, Taiwan.
Gynecol Oncol. 1997 Sep;66(3):372-7. doi: 10.1006/gyno.1997.4793.
In order to outline the pathways of gastrointestinal malignancies metastasizing to the ovaries, we reviewed 103 cases of metastatic ovarian tumors, and also performed para-aortic lymph node sampling on 11 patients at operation for metastatic ovarian tumors. Of the 103 patients, 74% (26/35) with gastric cancer and 67% (45/67) with colorectal cancer had lymph node metastasis at or before the diagnosis of ovarian tumor. Intraperitoneal metastases presented in 49 and 42% of patients with gastric and with colorectal cancers, respectively. Twenty-three percent of gastric cancer patients and 25% of colorectal cancer patients presented with both lymph node and intraperitoneal metastases. The ovary was the first or among the early metastatic organs diagnosed in 51 of the 53 patients with metachronous ovarian metastases. Only 4 patients with colorectal cancer and none with gastric cancer showed parenchymal organ metastases. These 4 patients also showed intraperitoneal lesions, and 3 of these 4 patients had node metastasis. Among the 11 patients who underwent prospective para-aortic lymph node sampling during operation for the ovarian tumors, only 1 had enlarged para-aortic nodes depicted by computed tomography, 2 had grossly enlarged (>/=1.5 cm) para-aortic lymph nodes noted at surgery, and 6 of the 7 patients with gastric cancer and all 3 with colorectal cancer had metastatic nodes histologically. Among the 58 nodes taken from these patients, 67% showed metastatic foci. We concluded that lymph node metastasis is frequently seen in patients with metastatic ovarian tumors of gastrointestinal origin, and hypothesized that retrograde lymphatic spread is a likely route for the metastases.
为了概述胃肠道恶性肿瘤转移至卵巢的途径，我们回顾了103例转移性卵巢肿瘤病例，并在11例转移性卵巢肿瘤手术患者中进行了腹主动脉旁淋巴结取样。在这103例患者中，74%（26/35）的胃癌患者和67%（45/67）的结直肠癌患者在卵巢肿瘤诊断时或之前已有淋巴结转移。胃癌和结直肠癌患者分别有49%和42%出现腹腔转移。23%的胃癌患者和25%的结直肠癌患者同时出现淋巴结和腹腔转移。在53例异时性卵巢转移患者中，51例患者的卵巢是首个或早期被诊断出的转移器官。只有4例结直肠癌患者出现实质器官转移，胃癌患者无一出现。这4例患者也有腹腔病变，其中3例有淋巴结转移。在11例因卵巢肿瘤手术而进行前瞻性腹主动脉旁淋巴结取样的患者中，只有1例通过计算机断层扫描显示腹主动脉旁淋巴结肿大，2例在手术中发现腹主动脉旁淋巴结明显肿大（≥1.5 cm），7例胃癌患者中的6例和所有3例结直肠癌患者的淋巴结在组织学上有转移。在从这些患者身上获取的58个淋巴结中，67%有转移灶。我们得出结论，胃肠道来源的转移性卵巢肿瘤患者中经常出现淋巴结转移，并推测逆行淋巴扩散可能是转移的途径。
