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Collision tumor of the colon--colonic adenocarcinoma and ovarian granulosa cell tumor.

Brahmania M, Kanthan CS, Kanthan R - World J Surg Oncol (2007)

Bottom Line: She developed lung metastases from the recurrent ovarian tumor within 6 months and died within a year of follow-up.Collision tumors of the colon are rare.Thus accurate identification and recognition of the second neoplasm is important as prognosis and survival may be determined by this component as seen in our index case.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, Canada. mab977@mail.usask.ca

ABSTRACT

Background: Collision tumors of the colon are rare. We report the first case, to our knowledge in the English literature, of a collision tumor composed of a colonic adenocarcinoma arising in a sigmoid diverticulum coexisting with a recurrent ovarian granulosa cell tumor.

Case presentation: A 64-year old woman presented with small bowel obstruction and a large, heterogenous, solid/cystic serosal based pelvic mass consistent with a gastrointestinal stromal tumor on imaging. Her significant past history 16-years ago included a bilateral salpingo-oophrectomy with hysterectomy. Surgical removal of the mass and pathological examination revealed the presence of a colonic adenocarcinoma arising in a large sigmoid diverticulum coexistent with a second neoplastic tumor phenotype; confirmed to be a delayed recurrent ovarian granulosa cell tumor. Though coexistent, the two tumor phenotypes respected their boundaries with no diffuse intermingling or transition between them. She developed lung metastases from the recurrent ovarian tumor within 6 months and died within a year of follow-up.

Conclusion: Collision tumors of the colon are rare. This is the first case reported of a collision tumor composed of adenocarcinoma colon and recurrent granulosa cell tumor representing an example of two independent tumors in a unique one-on-another collision. Clinical awareness and recognition of such tumors are important as they will dictate appropriate treatment strategies dependent on the individual biological aggressiveness of each of the tumor components. Our report highlights the need for histopathologists, surgeons, and oncologists to be aware of the rare possibility of collisions tumors. As seen in our case, the delayed recurrence of granulosa cell tumor of the ovary sixteen years after the initial presentation was the key determining factor in tumor recurrence, tumor progression, and tumor metastasis within three months, which ultimately lead to accelerated death within a year of clinical presentation. Thus accurate identification and recognition of the second neoplasm is important as prognosis and survival may be determined by this component as seen in our index case.

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A, B, C – Colonic adenocarcinoma colliding with granulosa cell tumor (3A) showing many architectural patterns including diffuse (3A) (asterisk), microfollicular (3B) and cords of cells (3C).
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Figure 3: A, B, C – Colonic adenocarcinoma colliding with granulosa cell tumor (3A) showing many architectural patterns including diffuse (3A) (asterisk), microfollicular (3B) and cords of cells (3C).

Mentions: Microscopically, the granulosa cell tumor was composed of fairly large monotonous cells with eosinophilic cytoplasm and nuclei being predominantly oval. Many architectural patterns including diffuse, micro-follicular and cords of neoplastic cells (Figure 3A, B, and 3C) were seen. The recurrence was predominantly seen along the peritoneal surface of the bowel and along the lateral pelvic wall. Isolated adenocarcinoma glandular cells were also identified fortuitously in some regions. Further sections showed the focus of the predominant growth of the typical dirty necrosis with glandular formation of a colonic adenocarcinoma to originate from a diverticular out pouching present within the serosal fat. Detailed sectioning confirmed the connection to the overlying colonic mucosa thus establishing the diverticular status of the bowel. The free "isolated" cells supported the view that the adenocarcinoma had perforated through the diverticulum and was present on the peritoneal surface. These "free tumor cells" though admixed with the granulosa cell tumor cells still respected their individual boundaries. Extensive co-existing diverticular disease of the sigmoid was also present. The adenocarcinoma component was moderately well-differentiated with the mucinous component representing less than 50% of the tumor and there was no evidence of a pre-existing polyp at the site of the carcinoma. The free serosal surface was involved by the ovarian granulosa cell tumor. Sampling of the subserosal fat showed evidence of irregular nodules keeping with venous invasion of an extramural variety along with perineural invasion both from the granulosa cell component. A small focus of giant cell granulomatous response was also observed in the serosal fat. The proximal and surgical margins of the lesion were free of tumor and no separate polyps were identified in the remainder of the bowel sampled. Twenty-one lymph nodes had been harvested from the specimen, of which, one was positive for the presence of metastatic colonic adenocarcinoma.


Collision tumor of the colon--colonic adenocarcinoma and ovarian granulosa cell tumor.

Brahmania M, Kanthan CS, Kanthan R - World J Surg Oncol (2007)

A, B, C – Colonic adenocarcinoma colliding with granulosa cell tumor (3A) showing many architectural patterns including diffuse (3A) (asterisk), microfollicular (3B) and cords of cells (3C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2164962&req=5

Figure 3: A, B, C – Colonic adenocarcinoma colliding with granulosa cell tumor (3A) showing many architectural patterns including diffuse (3A) (asterisk), microfollicular (3B) and cords of cells (3C).
Mentions: Microscopically, the granulosa cell tumor was composed of fairly large monotonous cells with eosinophilic cytoplasm and nuclei being predominantly oval. Many architectural patterns including diffuse, micro-follicular and cords of neoplastic cells (Figure 3A, B, and 3C) were seen. The recurrence was predominantly seen along the peritoneal surface of the bowel and along the lateral pelvic wall. Isolated adenocarcinoma glandular cells were also identified fortuitously in some regions. Further sections showed the focus of the predominant growth of the typical dirty necrosis with glandular formation of a colonic adenocarcinoma to originate from a diverticular out pouching present within the serosal fat. Detailed sectioning confirmed the connection to the overlying colonic mucosa thus establishing the diverticular status of the bowel. The free "isolated" cells supported the view that the adenocarcinoma had perforated through the diverticulum and was present on the peritoneal surface. These "free tumor cells" though admixed with the granulosa cell tumor cells still respected their individual boundaries. Extensive co-existing diverticular disease of the sigmoid was also present. The adenocarcinoma component was moderately well-differentiated with the mucinous component representing less than 50% of the tumor and there was no evidence of a pre-existing polyp at the site of the carcinoma. The free serosal surface was involved by the ovarian granulosa cell tumor. Sampling of the subserosal fat showed evidence of irregular nodules keeping with venous invasion of an extramural variety along with perineural invasion both from the granulosa cell component. A small focus of giant cell granulomatous response was also observed in the serosal fat. The proximal and surgical margins of the lesion were free of tumor and no separate polyps were identified in the remainder of the bowel sampled. Twenty-one lymph nodes had been harvested from the specimen, of which, one was positive for the presence of metastatic colonic adenocarcinoma.

Bottom Line: She developed lung metastases from the recurrent ovarian tumor within 6 months and died within a year of follow-up.Collision tumors of the colon are rare.Thus accurate identification and recognition of the second neoplasm is important as prognosis and survival may be determined by this component as seen in our index case.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, Canada. mab977@mail.usask.ca

ABSTRACT

Background: Collision tumors of the colon are rare. We report the first case, to our knowledge in the English literature, of a collision tumor composed of a colonic adenocarcinoma arising in a sigmoid diverticulum coexisting with a recurrent ovarian granulosa cell tumor.

Case presentation: A 64-year old woman presented with small bowel obstruction and a large, heterogenous, solid/cystic serosal based pelvic mass consistent with a gastrointestinal stromal tumor on imaging. Her significant past history 16-years ago included a bilateral salpingo-oophrectomy with hysterectomy. Surgical removal of the mass and pathological examination revealed the presence of a colonic adenocarcinoma arising in a large sigmoid diverticulum coexistent with a second neoplastic tumor phenotype; confirmed to be a delayed recurrent ovarian granulosa cell tumor. Though coexistent, the two tumor phenotypes respected their boundaries with no diffuse intermingling or transition between them. She developed lung metastases from the recurrent ovarian tumor within 6 months and died within a year of follow-up.

Conclusion: Collision tumors of the colon are rare. This is the first case reported of a collision tumor composed of adenocarcinoma colon and recurrent granulosa cell tumor representing an example of two independent tumors in a unique one-on-another collision. Clinical awareness and recognition of such tumors are important as they will dictate appropriate treatment strategies dependent on the individual biological aggressiveness of each of the tumor components. Our report highlights the need for histopathologists, surgeons, and oncologists to be aware of the rare possibility of collisions tumors. As seen in our case, the delayed recurrence of granulosa cell tumor of the ovary sixteen years after the initial presentation was the key determining factor in tumor recurrence, tumor progression, and tumor metastasis within three months, which ultimately lead to accelerated death within a year of clinical presentation. Thus accurate identification and recognition of the second neoplasm is important as prognosis and survival may be determined by this component as seen in our index case.

Show MeSH
Related in: MedlinePlus