Ovarian cancer recurrence manifested as a solitary intraluminal mass in ileum

Background: Most advanced ovarian cancer cases experience recurrence following primary treatment. While the majority of recurrences manifest within the peritoneal cavity or lymph nodes. Case: A rare case was reported where ovarian cancer recurred as a solitary mass within the ileal (small intestine) lumen after the patient achieving complete remission for more than one year. The medical records, including surgical findings and images, of a 49-year-old woman with recurrent ovarian endometrioid carcinoma were reviewed. The patient had initially undergone debulking surgery in 2020, with pathology confirming ovarian endometrioid carcinoma, right pelvic lymph node metastasis, and The International Federation of Gynecology and Obstetrics stage IIIC. After completing six courses of chemotherapy, the patient achieved complete remission. However, the patient continued experiencing frequent dyspepsia and black stool, despite no obvious elevation in tumor markers. Subsequent imaging revealed a right pelvic mass lesion months later. Exploratory laparotomy then found a solitary tumor mass within the ileal lumen, representing a recurrence of the metastatic endometrioid carcinoma. Conclusions: Clinicians should also consider less common sites of recurrence or metastasis, such as the intestinal lumen, when patients present with unexplained gastrointestinal symptoms.

Ovarian cancer; Intestinal metastasis; Recurrent ovarian cancer

[1] Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams gynecology. 4th edn. McGraw-Hill Education: New York. 2020.

[2] Desai A, Xu J, Aysola K, Qin Y, Okoli C, Hariprasad R, et al. Epithelial ovarian cancer: an overview. World Journal of Translational Medicine. 2014; 3: 1–8.

[3] Zheng S, Tian Q, Yuan Y, Sun S, Li T, Xia R, et al. Extracellular vesicle-packaged circBIRC6 from cancer-associated fibroblasts induce platinum resistance via SUMOylation modulation in pancreatic cancer. Journal of Experimental & Clinical Cancer Research. 2023; 42: 324.

[4] Ibrahim LI, Hajal C, Offeddu GS, Gillrie MR, Kamm RD. Omentum-on-a-chip: a multicellular, vascularized microfluidic model of the human peritoneum for the study of ovarian cancer metastases. Biomaterials. 2022; 288: 121728.

[5] Mei S, Chen X, Wang K, Chen Y. Tumor microenvironment in ovarian cancer peritoneal metastasis. Cancer Cell International. 2023; 23: 11.

[6] Rezniczek GA, Buggisch J, Sobilo J, Launay A, Lerondel S, Le Pape A, et al. Establishment of a mouse ovarian cancer and peritoneal metastasis model to study intraperitoneal chemotherapy. Cancers. 2020; 12: 3818.

[7] Zhang M, Cheng S, Jin Y, Zhao Y, Wang Y. Roles of CA125 in diagnosis, prediction, and oncogenesis of ovarian cancer. Biochimica et Biophysica Acta (BBA)—Reviews on Cancer. 2021; 1875: 188503.

[8] Motohara T, Masuda K, Morotti M, Zheng Y, El-Sahhar S, Chong KY, et al. An evolving story of the metastatic voyage of ovarian cancer cells: cellular and molecular orchestration of the adipose-rich metastatic microenvironment. Oncogene. 2019; 38: 2885–2898.

[9] Yousefi M, Dehghani S, Nosrati R, Ghanei M, Salmaninejad A, Rajaie S, et al. Current insights into the metastasis of epithelial ovarian cancer—hopes and hurdles. Cellular Oncology. 2020; 43: 515–538.

[10] Pennazio M, Spada C, Eliakim R, Keuchel M, May A, Mulder CJ, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2015; 47: 352–386.

[11] Al-Bawardy B, Shivashankar R, Proctor DD. Novel and emerging therapies for inflammatory bowel disease. Frontiers in Pharmacology. 2021; 12: 651415.

[12] Gore RM, Meyers MA. Pathways of abdominal and pelvic disease spread. In Gore RM, Levine MS (eds.) Textbook of gastrointestinal radiology (pp. 2099–2118). 3rd edn. Saunders: Philadelphia. 2008.

[13] Gopalaswamy R, Dusthackeer VNA, Kannayan S, Subbian S. Extrapulmonary tuberculosis—an update on the diagnosis, treatment and drug resistance. Journal of Respiration. 2021; 1: 141–164.

[14] Minardi AJ, Zibari GB, Aultman DF, McMillan RW, McDonald JC. Small-bowel tumors. Journal of the American College of Surgeons. 1998; 186: 664–668.

[15] O’Hanlan KA, Kargas S, Schreiber M, Burrs D, Mallipeddi P, Longacre T, et al. Ovarian carcinoma metastases to gastrointestinal tract appear to spread like colon carcinoma: implications for surgical resection. Gynecologic Oncology. 1995; 59: 200–206.

[16] Baiocchi G, Cestari LA, Macedo MP, Oliveira RA, Fukazawa EM, Faloppa CC, et al. Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection. Journal of Surgical Oncology. 2011; 104: 250–254.

[17] Kebapcı E, Gülseren V, Tuğmen C, Gökçü M, Solmaz U, Sert İ, et al. Outcomes of patients with advanced stage ovarian cancer with intestinal metastasis. Ginekologia Polska. 2017; 88: 537–542.

[18] Wu BZ. Intestinal metastasis and surgery in ovarian cancer: analysis of 62 cases. Chinese Journal of Obstetrics and Gynecology. 1989; 24: 224–227.

[19] Wu PC, Lang JH, Huang RL, Liu J, Tang MY, Lian LJ. Intestinal metastasis and operation in ovarian cancer: a report on 62 cases. Baillière’s Clinical Obstetrics and Gynaecology. 1989; 3: 95–108.

[20] Khadilkar SS, Samant M. OOPHORECTOMY: when and why? A novel risk stratification tool as an aid to decision making at gynecological surgeries. The Journal of Obstetrics and Gynecology of India. 2023; 73: 471–476.

[21] Rustin G, van der Burg M, Griffin C, Qian W, Swart AM. Early versus delayed treatment of relapsed ovarian cancer. The Lancet. 2011; 377: 380–381.

[22] Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound in Obstetrics and Gynecology. 2008; 31: 681–690.