Figure 1
CECT of the abdomen+pelvis, axial section, venous phase
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CECT-abdomen and pelvis. Axial section. Venous phase
Giant ovarian metastasis from sigmoid colon cancer
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsElisa Petraru, Iuliana Eva
Connected authors
48 years, female
Clinical History
A 48-year-old female presented with progressive abdominal distension, mild abdominal pain and discomfort.
At first, her symptoms were minor, but they increasingly worsened within a two month period.
At first, her symptoms were minor, but they increasingly worsened within a two month period.
Imaging Findings
A transabdominal ultrasound was performed, revealing a large, multiloculated, hypoechoic mass with relatively thick septa of approximately 250 mm/100mm in size.
The mass could not be precisely attributed to any organ, nor its extension into the nearby organs, due to its very large size.
Next, a CECT of the abdomen and pelvis (fig.1) was performed, which revealed:
-heterogeneous cystic mass of 164/232/240 mm in diameter, with septa and a 3 mm thick wall, both with contrast enhancement.
-circumferential asymmetrical thickening of the sigmoid wall, up to 11 mm
-peritoneal nodes
-adenopathies
-fluid in the pouch of Douglas (fig. 2, 3).
Given the findings, the supposition of adenocarcinoma of the sigmoid with ovarian metastasis was risen.
The patient underwent segmental colectomy, hysterectomy and bilateral adnexectomy (fig 4).
Eight months later she came for follow up and underwent a second CECT which showed a cystic mass with enhancing septa, located in the pelvic cavity of approximately 100/120 mm in diameter (fig. 5).
The mass could not be precisely attributed to any organ, nor its extension into the nearby organs, due to its very large size.
Next, a CECT of the abdomen and pelvis (fig.1) was performed, which revealed:
-heterogeneous cystic mass of 164/232/240 mm in diameter, with septa and a 3 mm thick wall, both with contrast enhancement.
-circumferential asymmetrical thickening of the sigmoid wall, up to 11 mm
-peritoneal nodes
-adenopathies
-fluid in the pouch of Douglas (fig. 2, 3).
Given the findings, the supposition of adenocarcinoma of the sigmoid with ovarian metastasis was risen.
The patient underwent segmental colectomy, hysterectomy and bilateral adnexectomy (fig 4).
Eight months later she came for follow up and underwent a second CECT which showed a cystic mass with enhancing septa, located in the pelvic cavity of approximately 100/120 mm in diameter (fig. 5).
Discussion
Krukenberg tumours account for about 1-2% of all ovarian cancers and they represent the secondary lesion from a primary mucin producing adenocarcinoma usually located in the gastrointestinal tract (stomach, colorectal, gallbladder, pancreas), the breast, lung, or the contralateral ovary.
Abdominal or pelvic pain, abdominal distention and bloating, dispareunia, or menometrorrhagia can be the presenting symptoms. Median age at diagnosis is 48 years [1].
Depending on the location of the primary lesion and the presence of ascites, peritoneal invasion and lymph node involvement the median overall survival is 16 months [1].
The particularity of the case consists in the size and unilaterality of the lesion, both of which usually indicate a local disease instead of a secondary tumour [2] as well as the local recurrence after initial treatment.
Ovaries represent a less frequent site for metastasis, but when in front of a patient with a pelvic cystic mass and free abdominal fluid, the possibility of a secondary lesion, should always be kept in mind as a differential diagnosis.
Abdominal or pelvic pain, abdominal distention and bloating, dispareunia, or menometrorrhagia can be the presenting symptoms. Median age at diagnosis is 48 years [1].
Depending on the location of the primary lesion and the presence of ascites, peritoneal invasion and lymph node involvement the median overall survival is 16 months [1].
The particularity of the case consists in the size and unilaterality of the lesion, both of which usually indicate a local disease instead of a secondary tumour [2] as well as the local recurrence after initial treatment.
Ovaries represent a less frequent site for metastasis, but when in front of a patient with a pelvic cystic mass and free abdominal fluid, the possibility of a secondary lesion, should always be kept in mind as a differential diagnosis.
Differential Diagnosis List
Mucinous adenocarcinoma of the sigmoid with left ovarian metastasis.
ovarian cystic adenoma
ovarian cystic adeocarcinoma
ovarian mucinous adenoma
ovarian mucinous adenocarcinoma
Final Diagnosis
Mucinous adenocarcinoma of the sigmoid with left ovarian metastasis.
References
[1] WU, XIAOAI ZHAO, BAIBING MI, LU FENG, NA YUAN, FUXI LEI MIN LI, XINHAN ZHAO (2015) Clinical characteristics and prognostic analysis of Krukenberg tumor. Mol Clin Oncol Nov; 3(6): 1323–1328.
[2] Seidman JD, Kurman RJ, Ronnett BM. (2003) Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am J Surg Pathol Jul;27(7):985-93. (PMID: 12826891)
Case information
| URL: | https://www.eurorad.org/case/14154 |
| DOI: | 10.1594/EURORAD/CASE.14154 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 3
CECT of the abdomen+pelvis, axial section, arterial phase
CECT of the abdomen+pelvis. Axial section. Arterial phase.
Large cystic mass, with enhancing capsule and septa and an area of sigmoid wall thickening.
Figure 4
Resection piece
Wall of the expansive ovarian cystic mass, devoid of its fluid content.
Figure 5
Follow-up CECT, axial section/saggital reconstruction, late phase
CECT of the abdomen+pelvis, saggital/coronal reconstruction, venous phase
CECT of the abdomen+pelvis, axial section, arterial phase
CECT of the abdomen+pelvis. Axial section. Arterial phase.
Large cystic mass, with enhancing capsule and septa and an area of sigmoid wall thickening.
Eva I, Department of Radiology, Iași, Romania
Eva I, Department of Radiology, Iași, Romania
Resection piece
Wall of the expansive ovarian cystic mass, devoid of its fluid content.
Department of Radiology, Emergency Military Hospital, Iași, Romania
Department of Radiology, Emergency Military Hospital, Iași, Romania
Follow-up CECT, axial section/saggital reconstruction, late phase
Follow up CECT of the abdomen and pelvis-late phase (10 minutes) showing local recurrence of the tumor with identical characteristics: cystic mass with enhancing septa
Department of Radiology, Emergency Military Hospital, Iași, Romania
Department of Radiology, Emergency Military Hospital, Iași, Romania
Follow up CECT- Saggital reconstruction-late phase showing reccurence of a 90mm cystic mass
Department of Radiology, Emergency Military Hospital, Iași, Romania
Department of Radiology, Emergency Military Hospital, Iași, Romania