Novel classification of ovarian metastases originating from colorectal cancer by radiological imaging and macroscopic ap
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ORIGINAL ARTICLE
Novel classification of ovarian metastases originating from colorectal cancer by radiological imaging and macroscopic appearance Mayumi Kobayashi Kato1 · Dai Shida2 · Yutaka Yoneoka1 · Hiroshi Yoshida3 · Naoyuki Miyasaka4 · Yukihide Kanemitsu2 · Tomoyasu Kato1 Received: 21 November 2019 / Accepted: 26 May 2020 © Japan Society of Clinical Oncology 2020
Abstract Background Diagnosis of secondary ovarian tumors originating from colorectal cancer has previously been based upon history of malignancy and radiological findings of bilateral masses with a “stained glass appearance.” The purpose of this study was to perform a detailed investigation of the radiological and macroscopic features of ovarian metastases originating from colorectal cancer, which remain to be fully characterized. Methods Study participants were 48 consecutive patients with ovarian metastases from colorectal cancer who underwent resection of ovarian tumors at the National Cancer Center Hospital between August 1998 and January 2019. Ovarian tumors were classified into subgroups using computed tomography (CT), magnetic resonance imaging (MRI), and macroscopic appearance. Results CT/MRI findings and macroscopic appearance were classified into the following four types: type 1 (oval, homogeneous-solid) (n = 5); type 2 (heterogeneous-solid, small in size with multinodular surface) (n = 3); type 3 (solid-cystic, predominantly solid) (n = 18); and type 4 (cystic-solid, multilocular with solid components) (n = 22). Type 1 mimics Krukenberg tumors, type 2 mimics ovarian metastases from breast cancer, type 3 mimics primary ovarian endometrioid cancer, and type 4 mimics primary ovarian mucinous cancer, with a “stained glass appearance”. Twenty-eight (58%) patients had bilateral metastases. Eleven patients (23%) underwent hysterectomy and/or pelvic lymph node dissection in addition to ovarian resection. Conclusion We introduced a novel classification system for ovarian metastases originating from colorectal cancer, which may be beneficial for assessing ovarian metastases from colorectal cancer and avoiding unnecessary surgery due to misdiagnosis of primary ovarian tumors. Keywords Ovarian metastases · Colorectal cancer · Krukenberg tumor · Primary ovarian mucinous tumors · Primary endometrioid ovarian cancer
* Dai Shida dshida‑[email protected] 1
Department of Gynecology, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑ku, Tokyo 1040045, Japan
2
Department of Colorectal Surgery, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑ku, Tokyo 1040045, Japan
3
Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑ku, Tokyo 1040045, Japan
4
Department of Perinatal and Women’s Medicine, Tokyo Medical and Dental University Hospital, 1‑5‑45 Yushima, Bunkyo‑ku, Tokyo 1138510, Japan
Abbreviations CA19-9 Carbohydrate antigen 19-9 CEA Carcinoembryonic antigen CT Computed tomography CK Cytokeratin MRI Magnetic resonance imaging USO Unilateral salpingo-oophorectomy BSO
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