27842595 Visualization

A 47 Age - year Age - old Age woman Sex presented Clinical_event to the hospital Nonbiological_location with a 1 Duration - month Duration history of abdominal Biological_structure distention Sign_symptom .
Physical Diagnostic_procedure examination Diagnostic_procedure revealed a huge Severity mass Sign_symptom in the lower Biological_structure abdomen Biological_structure .
The peripheral Diagnostic_procedure blood Diagnostic_procedure test Diagnostic_procedure showed elevated Lab_value levels of carcinoembryonic Diagnostic_procedure antigen Diagnostic_procedure ( CEA Diagnostic_procedure , 335.2 Lab_value ng/mL Lab_value [normal, <5 ng/mL]) and carbohydrate Diagnostic_procedure antigen Diagnostic_procedure ( CA Diagnostic_procedure ) 125 Detailed_description ( 219 Lab_value U/mL Lab_value [normal, <45 U/mL]) but a normal Lab_value level of CA19 Diagnostic_procedure - 9 Diagnostic_procedure ( 9 Lab_value U/mL Lab_value [normal, <37 U/mL]).
Computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) demonstrated a large Severity , round Shape mass Sign_symptom with a maximum diameter of 15 Distance cm Distance in the pelvic Biological_structure cavity Biological_structure without the presence of ascites Sign_symptom or pleural Sign_symptom effusion Sign_symptom (Fig.1a, ​b).
Colonoscopy Diagnostic_procedure identified an elevated Lab_value lesion Sign_symptom with severe Severity stenosis Sign_symptom in the sigmoid Biological_structure colon Biological_structure , and histopathological Diagnostic_procedure examination Diagnostic_procedure of biopsy Diagnostic_procedure specimens Diagnostic_procedure from the tumor Coreference showed moderately Lab_value differentiated Lab_value adenocarcinoma Disease_disorder .
Although we scheduled an early operation Therapeutic_procedure , the patient developed acute Lab_value dyspnea Sign_symptom and general Lab_value edema Sign_symptom 2 Date weeks Date after Date the first CT scan.
The second CT Diagnostic_procedure scan examination demonstrated massive Severity bilateral Detailed_description pleural Sign_symptom effusion Sign_symptom with atelectasis Sign_symptom and ascites Sign_symptom (Fig.2a, b).
Thoracic Therapeutic_procedure drainage Therapeutic_procedure and laparotomy Therapeutic_procedure were emergently performed.
Macroscopically Diagnostic_procedure , the tumor Coreference in the sigmoid Biological_structure colon Biological_structure had invaded Sign_symptom the serosa Biological_structure , and the huge Severity pelvic Biological_structure mass Sign_symptom was found to contain a right Detailed_description ovarian Disease_disorder tumor Disease_disorder .
Several small nodules Sign_symptom of peritoneal Biological_structure dissemination Sign_symptom were distributed over the greater Biological_structure omentum Biological_structure .
Perioperatively, 3800 Volume mL Volume of serous Lab_value ascitic Sign_symptom fluid Sign_symptom was drained Therapeutic_procedure .
Cytodiagnosis Diagnostic_procedure of the fluid Sign_symptom drained from the ascites Sign_symptom and pleural Sign_symptom effusion Sign_symptom revealed no Lab_value tumor Diagnostic_procedure cells Diagnostic_procedure .
Bilateral Detailed_description oophorectomy Therapeutic_procedure , total Detailed_description hysterectomy Therapeutic_procedure , omentectomy Therapeutic_procedure , and sigmoidectomy Therapeutic_procedure with regional Detailed_description node Therapeutic_procedure dissection Therapeutic_procedure were performed (Fig.3a).
Histopathological Diagnostic_procedure examination Diagnostic_procedure of the resected specimens showed moderately Lab_value differentiated Lab_value adenocarcinoma Disease_disorder in the tumors Sign_symptom of both the ovaries Biological_structure and the sigmoid Biological_structure colon Biological_structure (Fig.3b).
The dissected paracolic Biological_structure nodes Biological_structure showed malignant Sign_symptom cells Sign_symptom .
Immunohistochemically Diagnostic_procedure , tumor Sign_symptom cells Sign_symptom from the ovaries Biological_structure and the colon Biological_structure both showed positive Lab_value expression Lab_value of cytokeratin Diagnostic_procedure 20 Diagnostic_procedure ( CK20 Diagnostic_procedure ) but no Lab_value expression Lab_value of cytokeratin Diagnostic_procedure 7 Diagnostic_procedure ( CK7 Diagnostic_procedure ), confirming that the ovarian Disease_disorder tumors Disease_disorder were metastases Sign_symptom from primary Disease_disorder colon Disease_disorder cancer Disease_disorder (Fig.4a, ​b).
The postoperative Diagnostic_procedure course Diagnostic_procedure was uneventful Lab_value , and both pleural Sign_symptom effusion Sign_symptom and ascites Sign_symptom rapidly resolved.
Postoperatively, a regimen of 5 Medication - fluorouracil Medication ( 5 Medication - FU Medication ), leucovorin Medication , and oxaliplatin Medication ( FOLFOX Medication ) was administered every Frequency 2 Frequency weeks Frequency for Frequency 5 Frequency months Frequency .
At 29 Date months Date after Date the first operation, the patient required curative hepatic Biological_structure resection Therapeutic_procedure for liver Biological_structure metastases Sign_symptom .
At 78 Date months Date after Date the first operation, the patient remains alive Sign_symptom with no evidence of a disease Disease_disorder .