Synchronous metastatic colon carcinoma presenting as ovarian metastasis: a case report
Authors: Kashtalian Mykhailo , Chetverikova-Ovchynnyk Valeriia 
Published: June 2023

The aim of the study was to discuss a rare case of synchronously metastatic colon cancer, which clinically manifested as intestinal obstruction due to the presence of ovarian metastasis. Materials and methods. The clinical case of a 47-year-old patient with synchronously metastatic colorectal cancer with an affected disease, peritoneal carcinomatosis and metastatic ovarian lesions was analyzed. Case presentation. In July 2021, patient R., 47 years old, developed a clinic of sub-compensated intestinal obstruction. According to CT and MRI data, a volume formation of the small pelvis with a diameter of about 15 cm with compression of the surrounding soft tissues and metastases of the 6th and 4a segments of the liver were determined. According to a colonoscopy, a neoplasm of the sigmoid colon was verified as adenocarcinoma. The presence of peritoneal carcinomatosis was determined intraoperatively; the operation was performed in the following scope: SS-0 (complete cytoreduction) – right-sided ovariectomy with a tumour, resection of the sigmoid colon with a tumour, resection of the rectum with TME, extirpation of the cervical stump with the left ovary and pelvic peritonectomy en block resection and diathermocoagulation of foci of peritoneal carcinomatosis on the visceral peritoneum of the small intestine, omentectomy, radiofrequency ablation of a liver tumour under ultrasound guidance. According to histopathological examination: adenocarcinoma (G2) with foci of mucus production in the sigmoid colon, metastatic lesion of the right ovary, cervix, peritoneum, and liver. Subsequently, from September 2021 to July 2022, the patient underwent 8 courses of adjuvant polychemotherapy according to the FOLFOX scheme and 2 courses according to the FOLFOX scheme and bevacizumab. In August 2022, due to signs of disease progression, the patient underwent SS-0 cytoreductive surgery: removal of tumour nodes of the parietal and visceral peritoneum, partial peritonectomy of the anterior abdominal wall, argon plasma coagulation of foci of peritoneal carcinomatosis of the parietal and visceral peritoneum, resection of the round ligament of the liver, NIRES. According to the results of the histological examination, metastases of mucinous adenocarcinoma of the intestinal type with the II-III degree of medical pathomorphosis were determined. From September 2022, the patient received 2 courses according to the IRINOX + bevacizumab regimen and 6 courses according to the FOLFIRI + bevacizumab regimen. According to the control MRI of the abdominal organs with intravenous contrast, metastases of the 7th and 8th segments of the liver were determined. Performed percutaneous radiofrequency ablation of liver metastases under ultrasound control Results. According to the results of the MRI of the OCP with intravenous contrast, there are currently no data on the progression of the disease. The patient's quality of life is satisfactory; the ESOG score is 0. It has been 22 months since the onset of the disease. Conclusions. Cytoreductive surgical interventions for synchronously metastatic colorectal cancer can significantly improve patients' quality of life and their oncological outcomes rather than only symptomatic treatment.