Metastatic Colon Cancer Likely Secondary to Mixed Germ Cell Ovarian Cancer in a 21-year-old Asian Female: 1449

Most common cancers that metastasize to the gastrointestinal tract (GIT) are breast cancer, lung cancer and melanoma. Ovarian cancer rarely metastasizes to the GIT. We present a case of 21-year-old Asian female diagnosed with mixed germ cell tumor of the ovaries metastasizing to the colon. A 21-year-old healthy Asian female, pursuing master's degree, presented to the emergency room (ER) several times with abdominal discomfort and nausea. She was discharged from the ER four times over a period of 10 days with a diagnosis of pregnancy associated with urinary tract infection as his urine pregnancy test was positive. She then presented with worsening abdominal distension, nausea and vomiting. Physical examination showed diffusely tender and distended abdomen without any bowel sounds. A computed tomography of the abdomen and pelvis showed complete colon obstruction secondary to a mass and multiple liver lesions. She underwent emergent transverse colostomy. Flexible sigmoidoscopy showed an infiltrative mass in the descending colon. Biopsies showed poorly differentiated adenocarcinoma. Based on the tumor being immunoreactive with CK7, HCG, P53, PAX8, and negative to CK20, p16 and SALL4, primary ovarian tumor was suspected. Transvaginal ultrasound showed right ovarian 2.3 cm homogeneously echogenic mass with internal vascularity, concerning for primary or metastatic ovarian cancer. MRI of brain was negative for metastasis. PET scan showed multiple intensely FDG avid pelvic side walls, large circumferential descending colon mass, left external iliac lymph node, right paraspinal fat at T12/L1, porta hepatis and pancreatic head concerning for metastasis in all these areas. Based on young age, clinical presentation, pathology and immunophenotype, she was diagnosed with metastatic mixed germ cell ovarian carcinoma. She was started on chemotherapy with Bleomycin, Etoposide and Cisplatin. After completion of the 1st cycle, she was noted to have a clot in the right atrium, likely related to tumor, not amenable to surgery. A CT chest showed segmental pulmonary emboli. She is on therapeutic anticoagulation and currently receiving her second cycle of chemotherapy. Our case highlights the rarity of an ovarian cancer metastasizing to the colon in a young Asian female. She was erroneously informed of pregnancy based on the positive urine beta-HCG although this was likely related to the ovarian cancer.