Pure Primary Ovarian Squamous Cell Carcinoma Perforating the
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Ovarian squamous cell carcinomas are uncommon, with most arising from malignant transformation of a mature cystic teratoma. Only a few appear in pure form. Most patients with ovarian cancer present at an advanced stage and have a poor prognosis. Invasion into the serosal and muscular layer of the sigmoid colon and rectum by advanced ovarian cancer is common, but colorectal perforation is an extremely rare presentation. Although fistulae communicating with the bladder, rectum, and intestine are reported in malignant transformation of mature cystic teratoma, perforation by a pure primary ovarian squamous cell carcinoma has not been reported. We present a case of pure primary ovarian squamous cell carcinoma perforating the rectum.

Case Report
A 50-year-old woman visited a gastroenterology outpatient clinic complaining of rectal bleeding for several days. There was no significant past history. Rectosigmoidoscopy suggested perforation of a pelvic tumor into the proximal part of the rectum. A biopsy specimen showed squamous cell carcinoma. She was then referred to our hospital. She had no fever and no lower abdominal tenderness on physical examination. Gynecological examination revealed a firm, fixed, fist-sized mass in the pouch of Douglas. Transvaginal ultrasonography revealed a 9 cm heterogeneous, solid mass. There was no free fluid. Laboratory findings included a normal blood count and biochemical parameters. Tumor marker values were normal: CA 125, 9?units/mL (normal: 0–65?units/mL); CA 19-9, 26?units/mL (0–40 units/mL); carcinoembryonic antigen, 3?ng/mL (0.4–3.1?ng/mL); and squamous cell carcinoma antigen, 1.5?ng/mL (0–2?ng/mL). Abdominopelvic magnetic resonance imaging indicated a complex mass containing a pocket of air, which appeared to be separate from the uterus and was seen to penetrate the proximal part of the rectum (Figure 1). Computed tomography revealed several slightly enlarged pelvic lymph nodes....