RETROGRADE LYMPHATIC SPREAD - A LIKELY ROUTE FOR METASTATIC OVARIAN CANCERS OF GASTROINTESTINAL ORIGIN

In order to outline the pathways of gastrointestinal malignancies meta stasizing to the ovaries, we reviewed 103 cases of metastatic ovarian tumors, and also performed para-aortic lymph node sampling on 11 patie nts at operation for metastatic ovarian tumors. Of the 103 patients, 7 4% (26/35) with gastric cancer and 67% (45/67) with colorectal cancer had lymph node metastasis at or before the diagnosis of ovarian tumor. Intraperitoneal metastases presented in 49 and 42% of patients with g astric and with colorectal cancers, respectively. Twenty-three percent of gastric cancer patients and 25% of colorectal cancer patients pres ented with both lymph node and intraperitoneal metastases. The ovary w as the first or among the early metastatic organs diagnosed in 51 of t he 53 patients with metachronous ovarian metastases. Only 4 patients w ith colorectal cancer and none with gastric cancer showed parenchymal organ metastases. These 4 patients also showed intraperitoneal lesions , and 3 of these 4 patients had node metastasis. Among the 11 patients who underwent prospective para-aortic lymph node sampling during oper ation for the ovarian tumors, only 1 had enlarged para-aortic nodes de picted by computed tomography, 2 had grossly enlarged (greater than or equal to 1.5 cm) para-aortic lymph nodes noted at surgery, and 6 of t he 7 patients with gastric cancer and all 3 with colorectal cancer had metastatic nodes histologically. Among the 58 nodes taken from these patients, 67% showed metastatic foci. We concluded that lymph node met astasis is frequently seen in patients with metastatic ovarian tumors of gastrointestinal origin, and hypothesized that retrograde lymphatic spread is a likely route for the metastases. (C) 1997 Academic Press.