Histopathological assessment to detect colorectal ovarian micrometastasis following prophylactic salpingo-oophorectomy in postmenopausal patients

Abstract

Purpose Colorectal cancer (CRC) is one of the most prevalent malignancies and often leads to metastatic disease. Ovarian metastasis occurs in approximately 4% of all female CRC patients. Metastatic disease recurrence after intentional curative resection of primary colorectal tumour could be explained by the presence of micrometastases. The present study aims to investigate the prevalence of CRC (micro)metastases in tubo-ovarian tissue following prophylactic salpingo-oophorectomy (PSO) in postmenopausal patients. Methods Analyses of both adnexa of postmenopausal CRC patients who underwent primary tumour resection and concurrent PSO were conducted retrospectively. Tissue blocks with Formalin Fixed Paraffin Embedded ovarian tissue were sectioned at 5 levels and both routine histopathological and additional immunohistochemical staining for CK20 and CDx2 were performed. The primary outcome measure was incidence of CRC micrometastases (%). Results Ovaries of 100 consecutive CRC patients who underwent surgery at two Dutch teaching hospitals were analysed [age 72.7 ± 7.6 years, pT0-2 (43%) and pN0 (65%)]. Overall, ovarian malignancies were found in 4% of patients. Immunohistochemical analysis revealed no additional CRC (micro)metastases. Conclusion Additional immunohistochemical assessment did not reveal CRC ovarian (micro)metastases in an unselected patient cohort. The absence of micrometastases could be attributed to patient selection criteria and/or sampling error. Future research should focus on identifying a subgroup at high risk of developing ovarian metastasis and on improvement of diagnostic and therapeutic strategies.