OVARIAN TUMORS

Background: It is mandatory to distinguish between primary ovarian tumorsand metastases, as the treatment and prognoses are wide apart. Immunohistochemistry ismost frequently method being used to distinct these. Multiple studies showed that CDX2 ishallmark of the gut epithelium and is highly sensitive and specific immunohistochemical markerfor neoplasms of gastrointestinal origin. Objectives: In this case series study we have clinicallyand radiologically evaluated the cases of ovarian tumors referred to our institute, which arereported metastatic from colon based on expression of CDX2 marker. Study Design: Crosssectional observational study. Setting: Peoples University of Medical and Health Sciences forWomen (PUMHSW). Shaheed Benazir Abad. Period: Aug 2017 to September 2017. Patientsand Methods: 12 patients which were undergone oophrectomy and biopsy reported asmetastatic ovarian carcinoma from colon origin, based on histopathology features and CDX+immunohistochemistry marker, were included in our study. All the patients evaluated throughdetailed clinical history and examination, upper and lower GI endoscopy, CT scan wholeabdomen with contrast and tumor markers including CA 125, CEA, CA 19.9 and AFP). Results:No history of GIT specific symptoms like vomiting, constipation, diarrhea, bleeding per rectumwere noted in any patient. Upper and lower GIT endoscopies failed to identify any suspiciouslesion. No bowel related mass or wall thickening noted in CT scan abdomen with contrast.The serum level of CA 125 and CEA were only mildly raised in most patients. No evidence ofprimary colon lesion was noted in these patients inspite of extensive workup. Eventually thepatients were labeled and treated as primary carcinoma of ovary. Conclusions: CDX2 cannotbe used as sole indicator of colon origin and panel of the markers should always be employed,and clinical as well as radiological features should also be considered during interpretation ofIHC results.