抄録
Making a differential diagnosis is difficult between recurrent metastatic ovarian cancer and primary malignant ovarian tumor in patients who have a previous history of cancer and who are found to have ovarian tumor. We report a case of metastatic ovarian cancer in which diagnostic laparoscopic surgery was effective in deciding on the treatment strategy. A 46-year-old woman was referred to our department for a detailed examination. She was undergoing adjuvant chemotherapy after surgery for ileocecal cancer, which was diagnosed in the surgery department of our hospital when she was 45 years old. The serum levels of carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) were increasing, and a contrast-enhanced CT examination of the abdomen showed mild enlargement of her left ovary. Transvaginal ultrasound showed that both ovaries were of normal size, but diffusion-weighted MR imaging indicated a high intensity area in the left ovary. 18F-fluorodeoxyglucose (FDG) PET/CT showed abnormal accumulation of FDG in the left ovary and the right lower abdominal cavity. Diagnostic laparoscopic surgery was performed to differentiate between metastatic ovarian cancer and primary malignant ovarian tumor. Both adnexae were found to be of normal size intraoperatively, but an approximately 1 cm diameter tumor extending into the omentum was observed in the right lower quadrant. Laparoscopic left adnexectomy and omental tumorectomy were performed. The postoperative histopathologic diagnosis was metastatic adenocarcinoma. Diagnostic laparoscopic surgery is less invasive, so it is likely to be useful in making differential diagnoses and in deciding on appropriate treatment strategies.
