Complications of ovarian metastases from well-differentiated small bowel neuroendocrine neoplasms: a focus on bowel and ureteral obstruction.

INTRODUCTION

Ovarian metastasis from small bowel neuroendocrine neoplasms (SBNENs) was traditionally considered rare, but more recent series have suggested a higher prevalence. This case series seeks to examine the features and outcomes of patients with neuroendocrine ovarian metastases (NOM).

METHODS

Female patients with histologically confirmed well-differentiated SBNENs were identified using a prospectively maintained database (2014-2024). The electronic medical record was reviewed for details of diagnosis, histopathology, biomarkers, and outcomes among patients with and without NOM.

RESULTS

175 patients met inclusion criteria. 35 patients (20 %) had ovarian metastasis; for this group, 31.4 % had small bowel obstruction only, 5.7 % had ureteral obstruction only, and 14.3 % had both SBO and ureteral obstruction. 22 (62.9 %) also had peritoneal metastasis. 13 patients had ovarian metastasis but no peritoneal metastasis; within this group, 38.5 % had SBO, 15.4 % had ureteral obstruction, 76.9 % developed carcinoid syndrome, and 7.69 % died. There were no significant differences in rate of SBO (p = 0.280), ureteral obstruction (p = 0.716), or death (p = 0.091) between those with ovarian metastasis only and those with peritoneal metastasis only. Median overall survival was not reached.

CONCLUSION

This case series of female patients with SBNENs represents one of the largest available in the literature and demonstrates high rates of complications for those with ovarian metastasis, even in the absence of peritoneal metastasis. Prophylactic oophorectomy may be considered for SBNEN patients given the known development of severe complications throughout the progression of this disease where expectation for survival is lengthy.