A Case Report of Bilateral Endometrioid-Type Ovarian Carcinoma with Synchronous Dual Metastasis to the Colon

Abstract

Despite primary colorectal cancer being the third frequent malignancy worldwide, secondary metastasis to the large bowel from another primary cancer is seldom reported. Only a handful of previous cases of primary ovarian cancer metastasizing to the large bowel have been described in literature published in English up to date. We report a case of bilateral ovarian carcinoma with synchronous dual metastasis to the left colon, probably the first report of such nature. A 56-year-old Sri Lankan female presented with left-sided non-specific abdominal pain for 2 months. She was found to have bilateral ovarian tumours with elevated serum CA 125 levels, and near-occluding splenic flexure and descending colon masses. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, left hemicolectomy with regional lymph node dissection and omentectomy. Histology confirmed endometrioid adenocarcinoma of both ovaries with metastatic deposits in both colonic masses and in two out of seven lymph nodes along the left colic vascular pedicle. Both ovarian tumours and both colonic deposits were positively stained for ER and vimentin, and were negative for CK20 on immunohistochemistry indicating ovarian origin. The patient was disease-free at 2 years from the uncomplicated primary surgery having completed adjuvant chemotherapy. This case highlights the importance of the clinicians to be mindful of rare occurrences of large bowel secondary deposits of ovarian origin, especially when patients present with simultaneous large bowel and adnexal masses. Upfront bowel resection than neoadjuvant therapy could be performed safely in cases with impending bowel obstruction with satisfactory outcome.