Perspective of radiotherapy for ovarian metastasis from small cell lung cancer / 西安交通大学学报(医学版)

【Objective】 To evaluate the therapeutic value of radiotherapy for ovarian metastasis from small cell lung cancer. 【Methods】 Two patients with ovarian metastasis from small cell lung cancer were recruited, and the value of radiotherapy in the system treatment strategies was analyzed combined with literature reports. 【Results】 The two patients both benefited from local radiotherapy plus system treatment. One was still in complete remission, and compared to that reported in the literature, the local PFS improved to 21 months. 【Conclusion】 Although the prognosis of small cell lung cancer with ovarian metastasis is still poor, radiotherapy might be one of the systematic treatment strategies for improving the survival time of these patients.

Ovarian metastasis from colorectal adenocarcinoma / Metástase ovariana de adenocarcinoma colorretal

Introduction: Ovarian metastases of gastrointestinal origin, also called Krukenberg tumors, have a guarded prognosis. Physicians need to look for alternatives in diagnosis and treatment for this clinical condition in order to improve the outcome of the patients. Objectives: To report the experience of the authors in the treatment of these patients, and to perform a review of the literature on the epidemiology, clinical presentation, diagnosis, treatment, and prognosis for ovarian metastases from colorectal cancer. Methods: We collected clinical information regarding the patients treated for ovarian metastasis from colorectal adenocarcinoma at our coloproctology service, and performed a search on the PubMed database using the terms colorectal cancer, ovarian metastasis, Krukenberg tumor and surgery. Conclusion: Large abdominal tumors are the most frequent presentation of ovarian metastasis from colorectal cancer. The diagnosis is based on a histopathological analysis, levels of carcinoembryonic antigen (CEA) and cancer antigen 125 (CA-125), and immunohistochemical studies for the cytokeratin 20 (CK20), caudal-type homeobox 2 (CDX2) and vilina markers. Citoreductive surgical procedures are the most promising approach to treatment, with the highest impact on overall survival. The prognosis is negatively influenced by the extent of the metastasis, by citoreductive surgical procedures with persistence of macro- or microscopic foci of the disease, and by low scores on the general well-being index of the patient. (AU)

Introdução: As metástases ovarianas de tumores gastrointestinais, também chamadas de tumores de Krukenberg, são neoplasias de prognóstico reservado. Exigem conhecimento de alternativas diagnósticas e terapêuticas para garantir melhora da sobrevida das pacientes. Objetivos: Relatar a experiência dos autores no tratamento dessas pacientes, e fazer uma revisão da literatura sobre a epidemiologia, apresentação clínica, diagnóstico, tratamento e prognóstico das metástases ovarianas do câncer colorretal. Métodos: Foi realizada uma coleta de informações clínicas de pacientes tratados por metástases ovarianas de adenocarcinoma colorretal em nosso serviço de coloproctologia, em conjunto com uma pesquisa na base de dados PubMed com os termos colorectal cancer, ovarian metastasis, Krukenberg tumor, e surgery. Conclusão: Volumosas massas abdominais constituem a principal apresentação clínica da doença. As alternativas diagnósticas incluem a avaliação histopatológica, a identificação dos níveis de antígeno cárcino-embriônico (ACE) e de antígeno de câncer 125 (CA-125), e exame imunoistoquímico de espécimes cirúrgicos para os marcadores citoqueratina 20 (CK20), homeobox 2 do tipo caudal (CDX2), e vilina. O tratamento citorredutor completo demonstrou o maior impacto na sobrevida dos pacientes. O prognóstico é influenciado negativamente pela extensão da doença metastática, por cirurgia citorredutiva com persistência focos microscópicos ou macroscópicos da doença, e baixo escore de índice de bem-estar geral do paciente. (AU)

Clinicopathological characteristics and prognostic factors of 83 patients with ovarian metastasis from gastric cancer / 中国肿瘤临床

Objective: To explore the clinicopathological characteristics and prognostic factors of patients with ovarian metastasis from gastric cancer. Methods: We retrospectively analyzed the clinical data and treatment strategies of 83 patients with metastatic ovarian tumors treated at PLA General Hospital between January 2006 and December 2017. Univariate analysis using the Log-rank test and multivariate analysis using the Cox proportional-hazards model were used to identify the prognostic factors. Results: The median diam-eter of the metastatic ovarian tumors was 7.1 (1.0-24.0) cm. Of these patients, 36 (43.4%) had unilateral metastasis and 47 (56.6%) had bilateral metastasis; 35 (42.2%) patients had peritoneal metastasis. All patients received chemotherapy, including 57 (68.7%) pa-tients who underwent combined-modality resection of the metastatic tumors and 22 patients (26.5%) who received hyperthermic in-traperitoneal chemotherapy. Of these patients, 74 (89.1%) were followed up, with a median survival time of 15 [95% confidence inter-val (CI): 12.5-17.5] months. The 1-year, 3-year, and 5-year overall survival rates were 71.1%, 6.5%, and 0, respectively. Univariate analy-sis showed that risk factors including≥6 metastatic lymph nodes, metastasectomy, synchronous ovarian metastasis, peritoneal carcino-matosis, estrogen receptor (ER) positivity, and high levels of serum carcinoembryonic antigen and cancer antigen-125 (CA125) might af-fect the prognosis (P<0.05). Multivariate analysis showed that metastasectomy, synchronous ovarian metastasis, combined peritoneal carcinomatosis, and ER positivity were independent factors affecting prognosis (P<0.05). Conclusions: We found that the presence of synchronous ovarian metastasis or combined peritoneal carcinomatosis indicated a poor prognosis; in contrast, ER-positivity predicted a better prognosis than ER-negativity. Metastasectomy may prolong the survival of patients.

Analysis of clinical features and prognosis of breast cancer with uncommon metastases / 肿瘤

Objective: To analyze the clinical pathological characteristics and prognosis of breast cancer patients with uncommon metastases. Methods: Clinical data of 68 cases of breast cancer with uncommon metastases from 2012 to 2015 was retrospectively analyzed. The definition of uncommon sites of metastases is the metastatic sites except for lymph node, chest wall, breast, bone, liver, lung, brain and peritoneal and pleural metastases. Results: Among the 68 patients, the uncommon metastatic sites included adrenal gland, ovary, pancreas, eyes, uterus, spleen, rectum, bladder, kidney, thyroid gland and parotid gland. The top three common metastatic sites were adrenal gland (44.1%, 30/68), ovary (41.2%, 28/68) and pancreas (11.8%, 8/68); 75.0% (51/68) of the patients had other common metastases. The median survival time after uncommon metastases was 23.5 months (range: 1.4-116.0 months). The univariate analysis showed that the patients without metastases outside the special sites had a better survival than those with common metastases (median survival time were 36.0 and 18.0 months, respectively; P = 0.007). Conclusion: Breast cancer metastasis is widespread, in addition to the common sites, the cancer can be transferred to many other sites. Patients with uncommon metastases from breast cancer may have a favorable prognosis if they do not accompany with other common metastases, and local treatment may improve the survival of some selected patients. Many ovarian metastases are found after the operation, and the possibility of ovarian metastasis should be considered in the selection of the method of ovarian ablation.

The role of intratumoral lymphovascular density in distinguishing primary from secondary mucinous ovarian tumors

OBJECTIVE: Ovarian mucinous metastases commonly present as the first sign of the disease and are capable of simulating primary tumors. Our aim was to investigate the role of intratumoral lymphatic vascular density together with other surgical-pathological features in distinguishing primary from secondary mucinous ovarian tumors. METHODS: A total of 124 cases of mucinous tumors in the ovary (63 primary and 61 metastatic) were compared according to their clinicopathological features and immunohistochemical profiles. The intratumoral lymphatic vascular density was quantified by counting the number of vessels stained by the D2-40 antibody. RESULTS: Metastases occurred in older patients and were associated with a higher proportion of tumors smaller than 10.0 cm; bilaterality; extensive necrosis; extraovarian extension; increased expression of cytokeratin 20, CDX2, CA19.9 and MUC2; and decreased expression of cytokeratin 7, CA125 and MUC5AC. The lymphatic vascular density was increased among primary tumors. However, after multivariate analysis, the best predictors of a secondary tumor were a size of 10.0 cm or less, bilaterality and cytokeratin 7 negativity. Lack of MUC2 expression was an important factor excluding metastasis. CONCLUSIONS: The higher intratumoral lymphatic vascular density in primary tumors when compared with secondary lesions suggests differences in the microenvironment. However, considering the differential diagnosis, the best discriminator of a secondary tumor is the combination of tumor size, laterality and the pattern of expression of cytokeratin 7 and MUC2. .

Metástasis ovárica de carcinoma de células renales: presentación de un caso y revisión de la literatura / Ovarian metastasis of a renal cell carcinoma: presentation of a case and literature review

Se presenta un caso de metástasis ovárica secundaria a un carcinoma de células renales, en una paciente femenina de 35 años de edad, que al año de haber sido operada de carcinoma de células renales izquierdo por cirugía videolaparoscopica, se consultó por tumoración abdominal. En los estudios realizados se confirma una tumoración de ovario bilateral. La intervención quirúrgica consistió en histerectomía total con doble enexectomía y omentectomía. En el estudio histopatológico se confirmó metastásico del tumor primario renal operado un año antes. Los ovarios son sitios comunes de metástasis intrabdominales, alrededor de un 6 % del cáncer de ovario es secundario a tumores primarios en estómago, colon, mamas y los linfomas. Las metástasis en ovario de un carcinoma de células renales son muy infrecuentes.

We present a case of ovarian metastasis secondary to a renal cell carcinoma, in a female patient aged 35 years old, assisted the consultation for abdominal tumor a year after being operated of a left renal cell carcinoma by videolaparoscopic surgery. In the studies made we confirmed a bilateral ovarian tumor. In the histopathologic study we confirmed the renal primary tumor as metastatic. The ovaries are common places of intrabdominal metastasis; around the 6 % of the ovarian cancer is secondary to primary tumors in the stomach, colon, mammas and lymphomas. The ovarian metastasis of a renal cell carcinoma is very infrequent.

A Case of Pseudo-Meigs' Syndrome Associated with Ovarian Metastases from Breast Cancer / 한국유방암학회지

A 54-year-old woman with long-lasting pleural effusion developed abdominal distention due to ascites from bilateral ovarian tumors. The patient had undergone breast-conserving surgery and axillary lymph node dissection for left breast cancer in October 2000, and had developed left pleural effusion in July 2006. Cytological examination of the pleural effusion found no malignant cells. Thoracic drainage with intrathoracic administration of OK-432 (Picibanil) had failed to control the pleural effusion. Positron emission tomography taken at the abdominal distention showed bilateral ovarian tumors. After failure to control the ascites with systemic and intra-abdominal chemotherapy, bilateral oophorectomy resulted in normalization of elevated serum tumor-marker levels and the disappearance of both the ascites and pleural effusions (i.e., pseudo-Meigs' syndrome). Pathological examination showed the tumors to be estrogen receptor-positive metastatic ovarian tumors from her breast cancer. The patient remained well with no further recurrence for 40 months under aromatase inhibitor therapy.

Clinicopathological Characteristics of Ovarian Metastasis from Colorectal Cancer

PURPOSE: Treatment of ovarian metastasis from colorectal cancer has been controversial. We investigated the clinicopathologic features and treatment outcomes of patients with ovarian metastasis from colorectal carcinoma. METHODS: From January 1996 to May 2009, 567 women were treated for colorectal cancer. Of those, 23 patients were diagnosed as having ovarian metastasis. We reviewed 19 pathologically proven cases, retrospectively. RESULTS: The incidence of ovarian metastasis was 4.0%. The number of cases involving synchronous ovarian metastases was 9 (47.4%), and 10 cases (52.6%) involved metachronous ovarian metastases. Thirteen patients had metastases located in the pelvis and 6 also had peritoneal dissemination in addition to the ovarian metastasis. Twenty (63.1%) were treated with grossly complete resection. After a median follow-up duration of 45 months (range of 6~96 months), the median survival after the diagnosis of ovarian metastasis was 40 months. The median overall survival was significantly longer in the grossly complete resection group (48.5 vs. 16 months; P=0.001). For median survival after the diagnosis of ovarian-metastasis, patients with grossly complete resection showed a significantly more favorable survival rate than the group with remnant tumors (46.5 vs 9 months; P=0.009). The survival of patients with metastases located in the pelvis was better than the group with peritoneal dissemination. CONCLUSION: Grossly complete resection would be of help to improve the prognosis in selective patients with metastasis from colorectal cancer, especially when metastasis is located in the pelvis.

Utility of Surgical Resection in the Management of Metachronous Krukenberg's Tumors of Gastric Origin

PURPOSE: The aim of this study was to determine the prognostic factors and the significance of metastatectomy for Krukenberg's tumors of gastric origin. MATERIALS AND METHODS: Among the patient who underwent gastric surgery from 1992 through 2005, 90 female patients with Krukenberg's tumors of gastric origin were identified. We retrospectively reviewed the clinicopathologic characteristics, prognostic factors, and treatments for primary gastric cancer. We also investigated the prognostic risk factors for the onset of metachronous Krukenberg's tumors and the survival time of patients who underwent an operation for metachronous Krukenberg's tumors. RESULTS: The presence of a synchronous Krukenberg's tumor (mean survival time=17.6 months, P<0.01), peritoneal seeding (14.5 months, P<0.01), and non-curative resection (15.1 months, P<0.01), were statistically significant prognostic factors for survival time in female patients with gastric cancer. The stage of primary gastric cancer (P=0.049) and lymph node metastasis (P=0.011) were statistically significant risk factors for recurrence time of a metachronous Krukenberg's tumor. In the metachronous Krukenberg's tumor group (n=53), the mean survival time of the metastatectomy group (n=46, 43.2 months, P=0.012) was longer than that in the chemotherapy or conservative treatment groups (n=7 and 24 months, respectively). Metastatectomy, presense or abscence of residual tumor and extent of residual tumor were significant prognostic factors for survival time in female patients with metachronous Krukenberg's tumor of gastric origin. CONCLUSIONS: A close observation and evaluation with ultrasound or computed tomography is necessary in female patients with advanced gastric cancer to detect a metachronous Krukenberg's tumor as soon as possible. The surgeon must operate more aggressively in patients with metachronous Krukenberg's tumors.

Metastasis to the ovaries from transitional cell carcinoma of the bladder and renal pelvis: a report of two cases / 부인종양

Ovarian metastases from a primary urinary tract carcinoma are extremely rare. This can be difficult to distinguish from transitional cell carcinomas (TCC) of ovarian origin because of histologic similarity. A 65-year-old woman who was diagnosed with renal pelvis TCC 4 months prior was referred for evaluation of a left ovarian mass. A 47-year-old woman who underwent radical cystectomy due to bladder TCC 1 year ago was referred because of a right ovarian mass. Both patients underwent a bilateral salpingo-oophorectomy. The tumor cells had morphology identical to those of the primary urinary tract tumors. Gynecologic oncologists should consider metastatic TCC of the ovary from urinary tract origin, as well as breast, and gastrointestinal tract origins.

A case of ovarian metastasis on transposed ovary in patient treated for uterine cervical cancer / 대한산부인과학회지

In case of young women treated with ovarian preservation in cervical cancer surgery, it is regarded pertinent to reduce the risk of early menopause resulting from adjuvant pelvic irradiation through ovarian transposition. On the other hand, lots of authors have raised questions in regard with the ovary being possibly affected by micrometastasis. Studies have reported appropriate indications of ovarian transposition and risk factors of ovarian metastasis to cope with this problem. We conducted ovarian transposition with cervical cancer patient who had no ovarian metastasis risk factors reported in previous literature and experienced such case that metastasis took place only in the ovary without spreading to other organs. This study is to report that case based on brief literature review.

Uterine corpus involvement as well as histologic type is an independent predictor of ovarian metastasis in uterine cervical cancer / 부인종양

OBJECTIVE: This study aimed to investigate the independent risk factors for ovarian metastasis in cervical cancer. METHODS: Among 1,040 consecutive patients who underwent operation for cervical cancer at our institution from January 1998 to July 2007, a total of 625 patients had both ovaries removed during primary operation were retrospectively selected by medical records. In order to determine clinicopathological risk factors for ovarian metastasis, we analyzed patients' demographics, FIGO stage, and other pathologic findings. The Chi-square or Fisher's extract tests were used to compare any association of clinicopathologic variables with ovarian metastasis. For multivariate analysis, the log regression models were used to determine independent predictors for ovarian metastasis. RESULTS: Overall, ovarian metastasis was detected in fourteen (2.2%) patients: two of 473 patients with squamous cell carcinoma (0.4%) and twelve of 151 patients with non-squamous cell carcinoma (7.9%), respectively (p45 years: p=0.347), histologic types (squamous vs. non-squamous, p4 cm, p=0.054), stromal invasion (1/2, p=0.788), lymph node metastasis (positive vs. negative, p=0.007), parametrium (involved vs. uninvolved, p=0.145), upper vagina (involved vs. uninvolved, p=0.003), uterine corpus (involved vs. uninvolved, p<0.0001), and margin status (involved vs. uninvolved, p=0.017). By multivariate analysis, uterine corpus involvement was the only independent risk factor for ovarian metastasis (p=0.008), in addition to histologic types (p<0.0001). CONCLUSION: Based on our study, uterine involvement of cervical cancer is an independent predictor for ovarian metastasis, except histologic types. Ovarian preservation in cervical cancer may be safely performed only when no involvement of uterine corpus is present.

Clinical Characteristics of Ovarian Metastasis from Colorectal Cancer

PURPOSE: Treatment of ovarian metastasis from colorectal cancer has been controversial, and only limited data on ovarian metastasis have been reported. We reviewed the clinical features of patients with ovarian metastasis from a colorectal carcinoma. METHODS: From 1993 to 2002, 568 women were treated for colorectal cancer. Of those, 17 cases were diagnosed as ovarian metastasis. We reviewed the 17 cases retrospectively. RESULTS: The incidence of ovarian metastasis was 3.0% (17/568). The number of cases involving synchronous ovarian metastasis was 7 (1.2%). Those 7 patients also had another metastasis including ovarian metastasis. Ten cases (1.8%) involved metachronous ovarian metastasis. Of those 10 patients, 8 had ovarian metastasis in combination with other organ metastasis. The median disease-free interval from the diagnosis of the primary colorectal cancer to the diagnosis of ovarian metastasis was 9.8 months, and the median survival after the diagnosis of ovarian metastasis was 17.2 months. The median survival after the diagnosis of ovarian metastasis was 23.4 months in the ovarian- metastasis-only group, compared with 10.1 months in the group with ovarian and other metastasis. The difference in survival between the two groups was statistically significant. CONCLUSIONS: The incidence of ovarian metastasis from colorectal cancer was low. When such an event occurred, it was frequently associated with widespread disease and resulted in a poor prognosis. However, patients having only ovarian metastasis had a higher survival rate.

Two Cases of Low-Grade Endometrial Stromal Sarcoma / 대한산부인과학회잡지

Endometrial stromal sarcomas are rare uterine tumors accounting for about 0.2% of female genital tract malignancies, which are composed of cells closely resembling normal proliferative endometrial stromal cells. The tumor is classified into a low-grade and a high-grade variety on the basis of the mitotic rate. The low- grade endometrial stromal sarcoma has many synonyms, which include endolymphatic stromal myosis, stromatosis, stromal endometriosis and endometrioid sarcoma. Because the endometrial stromal sarcoma is very rare, the preoperative diagnosis and postoperative treatment are still difficult for clinicians. We have experienced two cases of low-grade endometrial stromal sarcoma of the uterus which are presented with a review of brief literature.

Two Cases of Low-Grade Endometrial Stromal Sarcoma / 대한산부인과학회잡지

Endometrial stromal sarcomas are rare uterine tumors accounting for about 0.2% of female genital tract malignancies, which are composed of cells closely resembling normal proliferative endometrial stromal cells. The tumor is classified into a low-grade and a high-grade variety on the basis of the mitotic rate. The low- grade endometrial stromal sarcoma has many synonyms, which include endolymphatic stromal myosis, stromatosis, stromal endometriosis and endometrioid sarcoma. Because the endometrial stromal sarcoma is very rare, the preoperative diagnosis and postoperative treatment are still difficult for clinicians. We have experienced two cases of low-grade endometrial stromal sarcoma of the uterus which are presented with a review of brief literature.

Diagnosis and treatment of gastric cancer with ovarian metastasis:a report of 17 cases / 中国普通外科杂志

Objective To investigate the clinical and pathological characteristics, diagnosis and treatment of gastric cancer with ovarian metastasis. Methods The clinical data of 17 cases of gastric cancer with ovarian metastasis, confirmed by surgery and pathology, were analyzed retrospectively. Results The average age of the patients was 48.41 years, and the first appearance of symptoms and signs often were of metastatic ovarian cancer. The main ultrasonographic findings were either a complex type of mass with both solid and cystic characteristics or only solid, and most of them were accompanied by intraperitoneal fluid accumulation. Bilateral metastatic ovarian cancer was more common(13 cases). The preoperative accurate diagnosis of this disease was difficult, so that the misdiagnostic rate was 64.7% in this series. Operation was done in all the patients, but prognosis was poor. The median survival time was only 11.6 months. Conclusions The prognosis of gastric cancer with ovarian metastasis is poor. It is of importance to inspect the stomach in cases of bilateral ovarian cancer. Radical resection of the primary disease focus together with hysterectomy and bilateral adnexectomy should be performed. Postoperative comprehensive therapy is conducive to improve the prognosis of gastric cancer with ovarian metastasis.

A case of transitional cell carcinoma of bladder, metastasis to ovary / 대한비뇨기과학회지

The incidence of ovarian metastasis of transitional cell carcinoma is very rare and its prognosis appears to be poor. We have experienced a unique case of ovarian metastasis from transitional cell carcinoma of the bladder in 59 year old female whose complaint was palpable abdominal mass. The patient previously underwent partial cystectomy due to perforation during transurethral resection of the bladder tumor. During the course of evaluation, left distal ureteral tumor was identified with cystic abdominal mass. On exploration, the palpable abdominal mass was confirmed as ovarian mass. She eventually underwent left oophorectomy and distal ureterectomy. The final diagnosis was confirmed as metastatic ovarian transitional cell carcinoma.