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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 – Collision tumor with the two neoplastic components seen with their individual staining pattern with cytokeratin 20 antibodies strongly positive in the adenocarcinomatous component (asterisk) in A and negative in the granulosa cell component (pound). While the vimentin antibodies are strongly positive in the granulosa cell component (asterisk) and negative in the adenocarcinomatous component (asterisk) in B. Inhibin staining pattern was identical to that seen with vimentin antibodies.
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Figure 4: A, B – Collision tumor with the two neoplastic components seen with their individual staining pattern with cytokeratin 20 antibodies strongly positive in the adenocarcinomatous component (asterisk) in A and negative in the granulosa cell component (pound). While the vimentin antibodies are strongly positive in the granulosa cell component (asterisk) and negative in the adenocarcinomatous component (asterisk) in B. Inhibin staining pattern was identical to that seen with vimentin antibodies.

Mentions: Immunohistochemical studies clearly delineated the two components of the collision tumor even in the closely admixed zones on the serosal surface of the lesion. The adenocarcinoma cells were strongly positive to low molecular weight keratin, and CK20 (Figure 4A), while CK7, vimentin, and S100 were negative. This immunohistochemical profile of CK20 being positive and CK7 being negative in the adenocarcinomatous component confirmed the histomorphological diagnosis of colonic adenocarcinoma. P53 antibodies were markedly over expressed in the majority of the adenocarcinoma cells. CA125 remained negative in these cells. Meanwhile, the granulosa cell tumor recurrence regions showed complete negativity to keratin antibodies (low molecular weight keratin, CK 7, CK 20), P53, and CA125. However, these cells were strongly positive to vimentin and inhibin (Figure 4B) with focal positivity with S100 antibodies. This immunohistochemical profile of CK7-, CK20-, inhibin+, vimentin+ confirmed the histomorphological diagnosis of granulosa cell tumor of the ovary. Table 1 summarizes the dilution, clone and the type of the antibodies used in this case.


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 – Collision tumor with the two neoplastic components seen with their individual staining pattern with cytokeratin 20 antibodies strongly positive in the adenocarcinomatous component (asterisk) in A and negative in the granulosa cell component (pound). While the vimentin antibodies are strongly positive in the granulosa cell component (asterisk) and negative in the adenocarcinomatous component (asterisk) in B. Inhibin staining pattern was identical to that seen with vimentin antibodies.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: A, B – Collision tumor with the two neoplastic components seen with their individual staining pattern with cytokeratin 20 antibodies strongly positive in the adenocarcinomatous component (asterisk) in A and negative in the granulosa cell component (pound). While the vimentin antibodies are strongly positive in the granulosa cell component (asterisk) and negative in the adenocarcinomatous component (asterisk) in B. Inhibin staining pattern was identical to that seen with vimentin antibodies.
Mentions: Immunohistochemical studies clearly delineated the two components of the collision tumor even in the closely admixed zones on the serosal surface of the lesion. The adenocarcinoma cells were strongly positive to low molecular weight keratin, and CK20 (Figure 4A), while CK7, vimentin, and S100 were negative. This immunohistochemical profile of CK20 being positive and CK7 being negative in the adenocarcinomatous component confirmed the histomorphological diagnosis of colonic adenocarcinoma. P53 antibodies were markedly over expressed in the majority of the adenocarcinoma cells. CA125 remained negative in these cells. Meanwhile, the granulosa cell tumor recurrence regions showed complete negativity to keratin antibodies (low molecular weight keratin, CK 7, CK 20), P53, and CA125. However, these cells were strongly positive to vimentin and inhibin (Figure 4B) with focal positivity with S100 antibodies. This immunohistochemical profile of CK7-, CK20-, inhibin+, vimentin+ confirmed the histomorphological diagnosis of granulosa cell tumor of the ovary. Table 1 summarizes the dilution, clone and the type of the antibodies used in this case.

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