Hepatic resection of giant metastatic tumor from clear cell carcinoma of the ovary

Abstract

All cancer patients, particularly those treated for colorectal cancer, should be monitored for the presence of liver metastases, but liver metastases from ovarian clear cell carcinoma are quite rare. We report a patient subjected to extended left hepatectomy due to a giant metastasis 5 years after surgical treatment for an ovarian neoplasm that was histopathologically diagnosed as clear cell carcinoma. A 58-year-old woman had undergone hysterectomy and bilateral salpingo-oophorectomy due to ovarian cancer (stage Ic). Four years and 8 months after the operation, a computed tomography (CT) scan demonstrated a giant tumor in the left lobe of the liver. The tumor compressed the inferior vena cava (IVC), but it was not clear whether it invaded the vessel. She received chemotherapy for 4 months; however, the tumor did not decrease in size. She was subsequently referred to our institution and was submitted to operation after it was confirmed that there were no distant metastases. After being subjected to an extended left hepatectomy and cholecystectomy, the patient recovered from the surgery without any complications. She has been carefully followed for 17 months and has presented no evidence of recurrence.

Liver Metastases from Gynecological Cancers: Time to Resection?

“…There is no scientific evidence to show that the presence of LM implies a worse prognosis in patients with stage IV [2,4,12,21]. Moreover, patients with perihepatic and intraperitoneal implants in which an optimal debulking surgery (residual disease < 1 cm) could be performed, a better survival is obtained compared with those that cannot be surgically treated (survival 50 months vs 7 months) [10,11,16,23,25].…”

“…The OC can produce liver metastases in two ways. The most frequent and rapid spread is due to exfoliated cells that are implanted into the surface of the abdominal organs, which correspond to liver implants on the Glisson capsule [4,10,11,17]. The second track, more rare, is the blood stream, causing parenchymal LM, and is the main subject of this review [4,11,17].…”

“…In recent years, technical improvements in liver resection and perioperative management have led to a dramatic decrease in morbidity and mortality associated with these procedures [1][2][3][4][5][6][7][8][9][10][11][12]. Resection of liver metastases (LM) of colorectal cancer and neuroendocrine tumors is currently the treatment of choice when technically feasible, with 5 years survival ranging from 35% -61% [1][2][3][4][5][6][7][8][9][10][12][13][14].…”

“…The number of patients undergoing resection of LMGC is very small [3,[5][6][7][8][9]15]. It has been estimated that LMGC are less than 1% of the total LM resected [10]. The low number of LMGC resections is probably due to the lack of defined criteria indicating which patients should be operated on, and the doubt whether a local treatment is useful in a disseminated disease [1,5,7,10,15,16].…”

“…It has been estimated that LMGC are less than 1% of the total LM resected [10]. The low number of LMGC resections is probably due to the lack of defined criteria indicating which patients should be operated on, and the doubt whether a local treatment is useful in a disseminated disease [1,5,7,10,15,16]. Moreover, there are no randomized trials comparing chemotherapy alone with LMGC surgical resection [5,17]…”