Case of Multiple Primary Carcinoma Involving the Rectum and Ovary

Abstract

The occurrence of primary carcinoma involving both the rectum and ovary has been found to be extremely rare. The record of only one such case has been published. This was by Rau (1) who, in 1922, reported a case in which both of these organs were the site of a primary carcinoma. The age of the patient and the types of carcinoma present were not recorded. In the case to be reported here a papillary cystic adenocarcinoma was found in a patient aged thirty-two, one year after resection of the rectum for adenocarcinoma. The incidence of multiple primary malignant tumors involving the colon and the ovary has been somewhat greater. In a very complete survey of the literature recently made by Warren and Gates (2), 6 cases were listed. The age in one was twenty-eight, and in the remainder ranged from forty to fifty-four. This age group, as in the present case, is considerably lower than the average age at which multiple primary malignant tumors usually have been found (3, 4). In the establishment of a diagnosis in the present case, the recognized criteria for multiple primary tumors were applied. The two important postulates of the three laid down by Billroth are believed to be adequately fulfilled. First, each growth showed distinct histologic differences which were sufficiently pronounced to exclude their interpretation as merely different stages of development. Second, each tumor sprang from its parent epithelium in different situations. The fulfillment of the third requirement, that each tumor must produce its own metastasis, could not be expected, in view of the clinical history of the case. The possibility that the second tumor may have been metastatic has been ruled out by the histologic differences and the fact that the ovary is not a common site for metastasis from rectal carcinoma.