0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Image of the Month—Diagnosis FREE

Arch Surg. 2008;143(4):422. doi:10.1001/archsurg.143.4.422.
Text Size: A A A
Published online

Histologic examination showed a moderately differentiated adenocarcinoma forming mucus-producing glands. The tumor cells stained positively for cytokeratins 20 and 7 and negative for estrogen receptors. The immunohistochemical profile was in keeping with metastatic colon cancer. The patient made an uneventful recovery and underwent palliative chemotherapy. Unfortunately, 18 months later her disease progressed to recurrent peritoneal disease.

Between 5% and 20% of ovarian tumors are metastatic from other malignancies.1 Of the gastrointestinal metastases, between 30% and 65% (second only to the stomach) originate from a colorectal primary malignancy.2

Colorectal metastases present either as Krukenberg tumors1 or as pseudo-Meigs syndrome (nonmalignant ascites or pleural effusions).3 Most are detected incidentally either during operation or preoperative imaging. The remainder present as recurrent disease. Sixty-six percent of deposits are bilateral.4 These tumors occur more commonly in the premenopausal patient, with 43% occurring in patients younger than 40 years.5 It is thought that metastatic spread occurs hematogenously rather than transserosally.4 Clinical symptoms of ovarian metastatic tumors are nonspecific abdominal pain, weight loss, abdominal bloating or swelling, uterine bleeding, and (rarely) rectal bleeding.6

Metastases to the ovary are often cystic (81%) on computed tomography and are difficult to differentiate from primary ovarian cancer.1 Macroscopically, these lesions, often smaller than 10 cm in diameter, have a smooth or nodular surface and the cystic lesions are usually filled with mucin or blood. There is a highly variable amount of stroma within these lesions and many contain nodules, foci of necrosis, and areas of hemorrhage. Microscopically, most of these tumors are formed by mucin-producing signet ring cells forming a wide range of nodules, glands, or cysts. Other epithelial cells may form the bulk of the deposits and in those cases are more likely to form tubular gland like structures.5

The presence of ovarian metastasis is a poor prognostic indicator, with a median survival time of 17 months.6 It appears that tumor size does not play a significant role in survival time.4 Treatment is aimed at alleviating symptoms and reducing tumor bulk. Most centers would advocate resection of the primary metastasis combined with bilateral salpingo-oophorectomy and hysterectomy.3,6,7 Operative debulking has been shown to rapidly improve symptoms in patients with pseudo-Meigs syndrome.3,7 Surgical resection should be followed by palliative chemotherapy, which has shown to provide a limited survival advantage.6

Return to

Due to the overwhelmingly positive response to the Image of the Month, the Archives of Surgery has temporarily discontinued accepting submissions for this feature. It is anticipated that requests for submissions will resume in mid-2008. Thank you.

Correspondence: Keith Towsey, MBBS, Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, Australia 4020 (ktowsey@hotmail.com).

Accepted for Publication: November 6, 2006.

Author Contributions:Study concept and design: Towsey and Lambrianides. Acquisition of data: Towsey, Lisle, and Lambrianides. Analysis and interpretation of data: Towsey. Drafting of the manuscript: Towsey and Lisle. Critical revision of the manuscript for important intellectual content: Lambrianides. Administrative, technical, and material support: Towsey. Study supervision: Lambrianides.

Financial Disclosure: None reported.

Choi  HLee  JHSeo  SS  et al.  Computed tomography findings of ovarian metastases from colon cancer: comparison with primary malignant ovarian tumors. J Comput Assist Tomogr 2005;29 (1) 69- 73
PubMed Link to Article
Renaud  MPlante  MRoy  M Metastatic gastrointestinal tract cancer presenting as ovarian carcinoma. J Obstet Gynaecol Can 2003;25 (10) 819- 824
PubMed
Nagakura  SShirai  YHatakeyama  K Pseudo-Meigs' syndrome caused by secondary ovarian tumours from gastrointestinal cancer: a case report and review of the literature. Dig Surg 2000;17 (4) 418- 419
PubMed Link to Article
Moore  RChung  MGranai  COGajewski  WSteinhoff  MM Incidence of metastasis to the ovaries from nongenital tract primary tumors. Gynecol Oncol 2004;93 (1) 87- 91
PubMed Link to Article
Kiyokawa  TYoung  RHScully  RE Krukenberg tumors of the ovary. Am J Surg Pathol 2006;30 (3) 277- 299
PubMed
Miller  BPittman  BWan  JYFleming  M Colon cancer with metastasis to the ovary at time of initial diagnosis. Gynecol Oncol 1997;66 (3) 368- 371
PubMed Link to Article
McGill  FRitter  DBRickard  CS  et al.  Krukenberg tumors: can management be improved? Gynecol Obstet Invest 1999;48 (1) 61- 65
PubMed Link to Article

Figures

Tables

References

Choi  HLee  JHSeo  SS  et al.  Computed tomography findings of ovarian metastases from colon cancer: comparison with primary malignant ovarian tumors. J Comput Assist Tomogr 2005;29 (1) 69- 73
PubMed Link to Article
Renaud  MPlante  MRoy  M Metastatic gastrointestinal tract cancer presenting as ovarian carcinoma. J Obstet Gynaecol Can 2003;25 (10) 819- 824
PubMed
Nagakura  SShirai  YHatakeyama  K Pseudo-Meigs' syndrome caused by secondary ovarian tumours from gastrointestinal cancer: a case report and review of the literature. Dig Surg 2000;17 (4) 418- 419
PubMed Link to Article
Moore  RChung  MGranai  COGajewski  WSteinhoff  MM Incidence of metastasis to the ovaries from nongenital tract primary tumors. Gynecol Oncol 2004;93 (1) 87- 91
PubMed Link to Article
Kiyokawa  TYoung  RHScully  RE Krukenberg tumors of the ovary. Am J Surg Pathol 2006;30 (3) 277- 299
PubMed
Miller  BPittman  BWan  JYFleming  M Colon cancer with metastasis to the ovary at time of initial diagnosis. Gynecol Oncol 1997;66 (3) 368- 371
PubMed Link to Article
McGill  FRitter  DBRickard  CS  et al.  Krukenberg tumors: can management be improved? Gynecol Obstet Invest 1999;48 (1) 61- 65
PubMed Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic