CASE 14154 Published on 06.11.2016

Giant ovarian metastasis from sigmoid colon cancer


Abdominal imaging

Case Type

Clinical Cases


Elisa Petraru, Iuliana Eva

Sos. Bucium Nr. 36 Bl. H Ap. 17 700282 Iasi;

48 years, female

Area of Interest Abdomen, Gastrointestinal tract, Genital / Reproductive system female, Oncology, Pelvis ; Imaging Technique CT
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.
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
-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).
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.
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.
Case information
DOI: 10.1594/EURORAD/CASE.14154
ISSN: 1563-4086