1532 Colorectal Metastasis of Ovarian Cancer: A Case Report

Abstract

INTRODUCTION: A 38-year-old Caucasian female with a history of stage IV clear cell carcinoma of the ovaries with metastasis to the liver presented with anemia. The patient presented to clinic for evaluation of symptomatic tachycardia and shortness of breath. She was found to have a hemoglobin of 6.2 at that time. On further questioning, the patient stated that she had been having bloody diarrhea for several days which had gradually been improving. She endorsed some lower abdominal pain along with increased swelling in her abdomen. The patient was admitted for a GI bleed at that time. The patient was on treatment with Abraxane and Carboplatin and was due for a second cycle, which was delayed due to significant cytopenias. CASE DESCRIPTION/METHODS: A colonoscopy was performed and the patient was found to have two ulcerated masses at 40 and 20 cm from the anal verge which were biopsied. CT chest abdomen pelvis was done upon admission and showed liver lesions, pelvic lymphadenopathy, small right ischiorectal fossa nodule and subcutaneous lesions concerning for metastatic disease. There were also lesions seen adjacent to the bladder concerning for drop metastasis. The patient also had a gastrograffin enema and was found to have scalloping of the margin of the distal sigmoid colon concerning for a mass. The pathology report and immunochemical stain evaluation revealed the adenocarcinoma to be positive for cytokeratin 7, negative for cytokeratin 20, negative for CDX2, and negative for WT-1 which argued against a colorectal primary. Surgical biopsy and pathology were also consistent with metastatic clear cell ovarian cancer. The patient did have an elevated CA-125 of 440.3. DISCUSSION: Four percent of ovarian carcinoma metastases are to the colorectal region. Isolated rectal metastasis is even more rare. Immunochemical stains are helpful in determining the primary lesion and source of malignancy. Cytokeratin 7 positive and cytokeratin 20 negative immunostaining is almost 100% specific for primary ovarian origin. 1 The patient was transfused blood and her hemoglobin improved with no further bleeding and she was discharged home. She was started on Carboplatin-Taxol every 3 weeks for six cycles and was going to be tested for the BRCA gene.