Colon adenocarcinoma with Krukenberg tumors, advanced pregnancy

Case contributed by Dr Yair Glick

Presentation

Evaluation of a left abdominal mass seen on perinatal ultrasonography.

Patient Data

Age: 35 years
Gender: Female

Concentric bowel wall thickening at the distal descending colon, showing diffusion restriction on DWIBS, with concomitant narrowing of the lumen - highly suspicious for carcinoma.

Large, cystic, multilocular structure in the middle and lower-middle abdomen measuring 13.3 x 8.5 x 12.5 cm, confluent with the left ovary and showing a high signal intensity on T2WI and a low, heterogeneous signal intensity on T1WI. The structure contains many internal septations, some of which are thickened, and displaces the gravid uterus to the right and the bowel loops. The evaluation of a solid component is limited without gadolinium injection.
Simple cystic structure in the right ovary measuring 2.6 cm in diameter.
The differential diagnosis for the simple cystic right ovarian lesion and large, multiloculated left ovarian mass - either mucinous cystadenoma/cystadenocarcinoma or Krukenberg tumors from the colon neoplasm.

Mild right hydronephrosis.

Minimal amount of fluid in the right paracolic gutter and the rectovesical pouch.

Case Discussion

The patient was initially referred from the gynecological department for the investigation of an incidental cystic-solid left abdominal mass seen on perinatal ultrasonography, for which she had the MRI shown here.

PATHOLOGY

Source of sample: colon - biopsy.
Microscopic description: fragments of colonic mucosa with adenocarcinoma.

Source of sample: left ovary.
Macroscopic description: mass weighing 304 g, measuring 11x10x7 cm. On sections - brown, pliable, cystic tissue with solid areas and thrombi.
Microscopic description - diagnosis: sections show moderately differentiated mucin-producing adenocarcinoma that stained positive for CDX-2 and SATB2 and negative for PAX-8, with extensive areas of necrosis.

Source of sample: left adnexa.
Macroscopic description: piece of brown, pliable tissue measuring 4x3x3 cm.
Microscopic description: sections from the ovary show one focus of adenocarcinoma with mucus production, m/p metastatic. The fallopian tube is without significant pathological changes.

Source of sample: omentum.
Macroscopic description: segment of omentum measuring 18x8x1.5 cm, edematous, without masses.
Microscopic description: fragment of omental tissue showing foci of adenocarcinoma.

The patient had a follow-up MRI that showed that the right ovarian cyst had grown and developed a multilocular appearance similar to that in the left ovary. Histopathology proved it to be metastatic adenocarcinoma as well.

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