PMC5360969_01
Case  1. Contrast-enhanced CT scan shows wall thickening of the sigmoid colon with enhancement (arrow; (a) axial plane) and a well-circumscribed and heterogeneously enhanced tumor of the ovary ((b) coronal plane). Chest X-ray shows a massive pleural effusion in right thorax (c).
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Contrast-enhanced CT scan displayed wall thickening of sigmoid colon and a huge intrapelvic tumor (Figures 1(a) and 1(b)). Her dyspnea worsened due to increased right pleural effusion (Figure 1(c)).
Changes in pleural effusion drainage during the perioperative period in case 1. The bars show amounts of pleural effusion drained from the right thorax each day throughout the clinical course.
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Thoracic drainage tube was inserted and 500-1000 mL of pleural effusion was removed each day (Figure 2).
Macroscopic findings of resected specimen from case 1. An ulcerative tumor in the sigmoid colon (a). The removed ovarian tumors weighed 1,102 g (left, (b)) and 490 g (right). The cut surface of the ovarian tumor shows focally villous appearance with cystic formation. Immunophenotype of a cytokeratin 7- (c) and cytokeratin 20+ (d) was seen in the ovarian tumor.
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In the sigmoid colon, a type 2 tumor, 55 x 35 mm in diameter, was observed (Figure 3(a)). Immunophenotype of a cytokeratin 7- (Figure 3(c)) and cytokeratin 20+ (Figure 3(d)) was seen in the ovarian tumors and they were considered to be metastasis of sigmoid colon cancer.
PMC5360969_02
Case  2. Contrast-enhanced CT scan shows a well-circumscribed and heterogeneously enhanced tumor of the ovary ((a) coronal plane) and wall thickening of the ascending colon with enhancement (arrow; (b) axial plane). MRI T2 shows cystic masses in the pelvis ((c) coronal plane).
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CA-125: 1400.7 U/mL). Colonoscopy showed a type 3 tumor in the ascending colon, and a biopsy specimen revealed well-differentiated adenocarcinoma. CT scan displayed bilateral pleural effusion, massive ascites, wall thickening of the ascending colon with enhancement, and bilateral cystic ovarian tumors that were about 20 cm in diameter (Figures 4(a) and 4(b)). T2 showed polycystic tumors in the bilateral ovaries (Figure 4(c)). The patient needed paracentesis every two or three days to improve abdominal distension (Figure 5).
Changes in ascites and pleural effusion drainage in the perioperative period in case 2. The bars show amounts of ascites (solid) that was aspirated each day, and the broken line shows the amounts of pleural effusion drained each day throughout the clinical course.
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T2 showed polycystic tumors in the bilateral ovaries (Figure 4(c)). The patient needed paracentesis every two or three days to improve abdominal distension (Figure 5).
PMC5360969_03
Contrast-enhanced CT scan in case 3 shows pleural effusion in the right thorax ((a) axial plane) and ascites along with a well-circumscribed and heterogeneously enhanced tumor of the rt. ovary ((b) coronal plane).
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However, 3 months later, the patient felt abdominal distension, and CT scan revealed an ovarian tumor and right pleural effusion (Figure 6).
Changes in serum levels of tumor markers and body weight after primary colectomy and chemotherapy in case 3. LAR, lower anterior resection; XELOX, capecitabine and oxaliplatin.
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After operation, the ascites and pleural effusion resolved (Figure 7).