Metastatic primary non-resectable colorectal cancer mimicking ovarian cancer in a 38-year old pregnant woman

Abstract

We report a very rare case of a 38-year old woman coming in for a planned gynaecological examination in 12th week of pregnancy suffering from symptoms considered to be associated with her pregnancy. The ultrasound picture showed a missed pregnancy and a suspicious ovarian cyst and the patient was referred to University Hospital Brno. After examination there was a strong suspicion for ovarian cancer with ascites and peritoneal and liver metastases. The biopsy from a mass of posterior vaginal wall was performed and pathologist's conclusion was grade II adenocarcinoma, possibly ovarian origin. Subsequently according to the immunohistochemical analysis the pathologist recommended to examine possibility of colorectal origin of the tumour. The start of systemic therapy was postponed and colonoscopy finding was a polypoid infiltration of sigmoid colon in 28 cm. Complementary circulating tumour markers specific to colorectal cancer were highly elevated. The conclusion according to immunohistochemistry was moderately differentiated adenocarcinoma most likely of colorectal origin. A diagnosis of a metastatic primary non-resectable colorectal cancer was made and systemic chemotherapy in combination with biological therapy tailored to this type of cancer was administered.