Early stage rectal cancer metastatic to the ovary.
A 60-year-old Caucasian woman without a significant medical history
was diagnosed with a rectal mass 12 cm from the anal verge on screening
examination in March 2003. A low anterior resection was performed
revealing a moderately differentiated adenocarcinoma extending to the
submucosal layer. None of the lymph nodes removed had evidence of
metastatic disease, thus the tumor was classified as a Stage I
(Duke's A) cancer of the rectum (T1, N0, M0). The pre-op CEA level
was 1.7 ng/ml. In July 2003, the patient reported occasional lower
abdominal pain. Repeat CEA level was 2.0 ng/ml and a CT scan of the
abdomen and pelvis revealed only uterine fibroids. Surveillance
colonoscopy in September 2003 was within normal limits, however the CEA
level increased to 8.7 ng/ml one month later. A second CT scan of the
abdomen and pelvis again showed only uterine fibroids. In November 2003,
the CEA level was 15.2 ng/ml. Since the preceding work-up of the rising
CEA was unrevealing, a whole body PET scan was obtained. The PET images
demonstrated one suspicious hypermetabolic lesion in the pelvis just to
the right of the midline. A combination PET/CT scan showed the
hypermetabolic lesion in the right ovary. Upon exploratory laparotomy, a
firm 3 cm mass was palpated within the right ovary. A bilateral
salpingo-oophorectomy was performed revealing adenocarcinoma consistent
with metastatic rectal cancer within the right ovary. There was no
evidence of metastatic disease in the left ovary, the fallopian tubes,
or the multiple lymph nodes removed. Metastatic disease to the ovaries is uncommon. Among patients with ovarian metastases from colorectal
cancer, most have either bilateral ovarian involvement or distant
metastatic disease. To our knowledge, this is the first reported case of
an isolated, unilateral ovarian metastasis from colorectal cancer that
was initially detected by a PET scan.
Asghar Naqvi, MD, Celyne L. Bueno, MD, and Derrick W. Spell, MD.
Louisiana State University Health Sciences Center, Division of
Hematology/Oncology, Department of Internal Medicine, Earl K. Long
Medical Center, Baton Rouge, LA.