内容紹介
A Case of Pseudo-Meigs Syndrome Associated with Metachronous Ovarian Metastasis from Ascending Colon Cancer
Summary
We experienced a case of pseudo-Meigs syndrome associated with metachronous metastasis to the ovary from ascending colon cancer. A 65-year-old woman underwent curative surgery for ascending colon cancer at another hospital. A follow-up CT carried out 3 months after the surgery revealed a right ovarian tumor and a large amount of ascites. The patient was diagnosed with ovarian metastasis from ascending colon cancer with carcinomatous peritonitis. Palliative care was recommended, and she presented at our department for a second opinion. In spite of a large amount of ascites and pleural effusion, no disseminating tumor was detected on contrast-enhanced CT at our hospital, and we recommended that she undergo a diagnostic laparotomy. The laparotomy was negative for carcinomatous peritonitis and a right oophorectomy was performed. The histopathological findings indicated that the ovarian tumor was consistent with metastasis from ascending colon cancer. After the surgery, we initiated chemotherapy with mFOLFOX6+bevacizumab and the symptoms were well controlled. A follow-up CT carried out 11 months after the surgery revealed a left ovarian tumor and increased ascites, and the patient underwent a left oophorectomy. Then, chemotherapy with the same regimen was administered for 12 months, and she did not develop any signs of recurrence for 27 months after the surgery. Ovarian metastasis from colon cancer may occasionally cause pseudo-Meigs syndrome, and it is important to be aware of the usefulness of oophorectomy for the control of ascites and pleural effusion.
要旨
上行結腸の癌異時性卵巣転移によるpseudo-Meigs症候群の1例を経験した。症例は65歳,女性。他院で上行結腸癌の根治切除を受けたが術後3か月目に胸腹水が出現し,癌性腹膜炎と診断され緩和治療の方針を示されたため,セカンドオピニオンを希望し当科を受診した。CEA,CA125は高値を示し,CTで胸腹水および右卵巣腫瘍を認めたが,明らかな播種性病変を認めなかったことより,腹腔内観察と腫大した卵巣切除を目的に手術を施行した。病理組織診の結果からは上行結腸癌卵巣転移と診断されたが,開腹所見では癌性腹膜炎は否定的であった。術後,mFOLFOX6+bevacizumabを導入したが,11か月目に対側の卵巣転移から同様の症状を呈したため再手術で左卵巣を摘出した。その後も同レジメンで化学療法を1年間継続し,術後2年3か月を経た現在まで再発兆候はない。胸腹水を合併した卵巣腫瘍に対しては本症候群を念頭に置き,積極的に切除を考慮すべきであると考える。
目次
Summary
We experienced a case of pseudo-Meigs syndrome associated with metachronous metastasis to the ovary from ascending colon cancer. A 65-year-old woman underwent curative surgery for ascending colon cancer at another hospital. A follow-up CT carried out 3 months after the surgery revealed a right ovarian tumor and a large amount of ascites. The patient was diagnosed with ovarian metastasis from ascending colon cancer with carcinomatous peritonitis. Palliative care was recommended, and she presented at our department for a second opinion. In spite of a large amount of ascites and pleural effusion, no disseminating tumor was detected on contrast-enhanced CT at our hospital, and we recommended that she undergo a diagnostic laparotomy. The laparotomy was negative for carcinomatous peritonitis and a right oophorectomy was performed. The histopathological findings indicated that the ovarian tumor was consistent with metastasis from ascending colon cancer. After the surgery, we initiated chemotherapy with mFOLFOX6+bevacizumab and the symptoms were well controlled. A follow-up CT carried out 11 months after the surgery revealed a left ovarian tumor and increased ascites, and the patient underwent a left oophorectomy. Then, chemotherapy with the same regimen was administered for 12 months, and she did not develop any signs of recurrence for 27 months after the surgery. Ovarian metastasis from colon cancer may occasionally cause pseudo-Meigs syndrome, and it is important to be aware of the usefulness of oophorectomy for the control of ascites and pleural effusion.
要旨
上行結腸の癌異時性卵巣転移によるpseudo-Meigs症候群の1例を経験した。症例は65歳,女性。他院で上行結腸癌の根治切除を受けたが術後3か月目に胸腹水が出現し,癌性腹膜炎と診断され緩和治療の方針を示されたため,セカンドオピニオンを希望し当科を受診した。CEA,CA125は高値を示し,CTで胸腹水および右卵巣腫瘍を認めたが,明らかな播種性病変を認めなかったことより,腹腔内観察と腫大した卵巣切除を目的に手術を施行した。病理組織診の結果からは上行結腸癌卵巣転移と診断されたが,開腹所見では癌性腹膜炎は否定的であった。術後,mFOLFOX6+bevacizumabを導入したが,11か月目に対側の卵巣転移から同様の症状を呈したため再手術で左卵巣を摘出した。その後も同レジメンで化学療法を1年間継続し,術後2年3か月を経た現在まで再発兆候はない。胸腹水を合併した卵巣腫瘍に対しては本症候群を念頭に置き,積極的に切除を考慮すべきであると考える。