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Case of the Month



Ovarian Serous Carcinoma

History: 46-year-old female presented with history of heartburn, weight loss, bloating, change in bowel habits, decreased appetite, and non-intractable cyclical vomiting with nausea. The patient underwent lower endoscopy and biopsy of the sigmoid colon was performed.

The biopsy shows colonic mucosa with tumor cells in the lamina propria and submucosa forming nests and gland-like structures associated with numerous psammoma bodies. The overlying epithelium is negative for dysplasia. Immunoperoxidase stains show that tumor cells stain positive with CK7, PAX8 and negative with CK20. The staining pattern is compatible with a Serous Carcinoma of Gynecologic Origin. Further work up showed Ovarian Serous Carcinoma. Four pathways are thought to cause involvement of colonic mucosa by ovarian carcinoma. These include hematogenous spread, lymphatic spread, direct invasion, and peritoneal dissemination.