OVARIAN TUMORS

CDX2 IS NOT THE SOLE INDICATOR OF INTESTINAL ORIGIN CANCER IN PATIENTS PRESENTED WITH OVARIAN TUMORS

Abstract

Background: It is mandatory to distinguish between primary ovarian tumors
and metastases, as the treatment and prognoses are wide apart. Immunohistochemistry is
most frequently method being used to distinct these. Multiple studies showed that CDX2 is
hallmark of the gut epithelium and is highly sensitive and specific immunohistochemical marker
for neoplasms of gastrointestinal origin. Objectives: In this case series study we have clinically
and radiologically evaluated the cases of ovarian tumors referred to our institute, which are
reported metastatic from colon based on expression of CDX2 marker. Study Design: Cross
sectional observational study. Setting: Peoples University of Medical and Health Sciences for
Women (PUMHSW). Shaheed Benazir Abad. Period: Aug 2017 to September 2017. Patients
and Methods: 12 patients which were undergone oophrectomy and biopsy reported as
metastatic ovarian carcinoma from colon origin, based on histopathology features and CDX+
immunohistochemistry marker, were included in our study. All the patients evaluated through
detailed clinical history and examination, upper and lower GI endoscopy, CT scan whole
abdomen 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 rectum
were noted in any patient. Upper and lower GIT endoscopies failed to identify any suspicious
lesion. 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 of
primary colon lesion was noted in these patients inspite of extensive workup. Eventually the
patients were labeled and treated as primary carcinoma of ovary. Conclusions: CDX2 cannot
be 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 of
IHC results.