RESUMO
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)
Assuntos
Humanos , Feminino , Neoplasias Ovarianas/etiologia , Adenocarcinoma , Tumor de Krukenberg , Metástase Neoplásica , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/terapia , Neoplasias Colorretais/complicações , Procedimentos Cirúrgicos de CitorreduçãoRESUMO
Breast is one of the most common primary origins of secondary ovarian cancer. There are some factors that influence the incidence of ovarian metastases (OM), such as histological type of primary cancer. OM from breast cancers are frequently asymptomatic until the masses have grown to certain size, and the metastatic tumors are frequently manifested as bilateral, solid, small ovarian masses. On the other hand, patients with a history of breast cancer have an increased risk of developing primary ovarian cancer (POC) than the general population. To differentiate OM from POC is essential as the optimal treatments and prognosis are distinct. Medical history, clinical manifestation, imaging examinations, serological examinations, and pathology (including immunohistochemical, genomic and transcriptomic approach) are all essential elements to improve the diagnostic accuracy. Breast cancer patients with OM have a poor prognosis; surgical resection with systemic therapy may help prolong the survival.
Assuntos
Neoplasias da Mama/patologia , Neoplasias Ovarianas/secundário , Feminino , Humanos , PrognósticoRESUMO
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. .
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/secundário , Vasos Linfáticos/patologia , Neoplasias Ovarianas/patologia , Adenocarcinoma Mucinoso/química , /análise , Diagnóstico Diferencial , Imuno-Histoquímica , Queratinas/análise , Metástase Linfática , Vasos Linfáticos/química , Glicoproteínas de Membrana/análise , Proteínas de Membrana/análise , Mucinas/análise , Neoplasias Ovarianas/química , Valores de Referência , Análise Serial de Tecidos , Carga Tumoral , Biomarcadores Tumorais/análiseRESUMO
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.