Magnification linked color imaging characterization of the irregular vessel network of diffuse mucosal rectal metastatic spread from high-grade serous ovarian cancer

Vincent Zimmer1,2, Elke Eltze3

Dig Liver Dis. 2020 Oct 17;S1590-8658(20)30931-2. doi: 10.1016/j.dld.2020.10.002. Online ahead of print.

A 62-year-old female patient presented with lower abdominal pain in combination with a 2-kg weight loss and stool retention. Medical history was significant for ovarian cancer that was treated by curative-intent surgery and adjuvant chemotherapy two years before. Imaging studies were consistent with peritoneal carcinomatosis and suggested incipient large bowel obstruction, for which the patient underwent lower GI endoscopy. While a high-grade stricture at the rectosigmoidal junction due to external compression precluded scope advancement, apart from mild unspecific erythema multiple nodular aphthoid-like lesions were identified throughout the rectum (Fig. 1A). Further endoscopic assessment including magnification image-enhanced endoscopy was performed. On blue laser imaging (BLI) no pit pattern was discernible (Fig. 1B). Linked color imaging (LCI) in escalating magnification levels, however, clearly depicted an irregular vessel network within the lesion with avascular areas, marked caliber changes, curtailed interruptions, tortuosity up to irregular loop formation (Fig. 1C,D). Overall, these findings were highly suggestive of diffuse multi-nodular metastases as an exceedingly uncommon type of gastrointestinal metastatic spread in ovarian cancer [1]. This was confirmed by final pathology indicating mucosal infiltration by atypical solid, in part, papillary epithelial complexes (Fig. 2A,B) with CK-7 and WT-1 positivity (Fig. 2C,D) and lymphovascular invasion, consistent with recurrent high-grade serous ovarian cancer.

1 Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany
2 Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
3 Institute of Pathology Saarbrücken-Rastpfuhl, Saarbrücken, Germany