Difference between revisions of "Ovarian metastasis"
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An '''ovarian metastasis''' (also '''ovary with metastatic disease''') is [[cancer]] in the [[ovary]] that arose elsewhere and spread to the ovary. | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Adenocarcinoma_of_the_breast_metastatic_to_the_ovary_-_low_mag.jpg | |||
| Width = | |||
| Caption = Ovary with a metastasis from breast carcinoma (left of image). [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = predominantly surface involvement and nodular (especially at low power), +/-signet ring cells (suggestive of GI or breast primary), [[lymphovascular invasion]] | |||
| Subtypes = | |||
| LMDDx = ovarian primary tumours - esp. [[ovarian mucinous carcinoma]], [[serous carcinoma of the ovary]], [[endometrioid carcinoma of the ovary]] | |||
| Stains = | |||
| IHC = dependent on primary site | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = classically bilateral masses <10 cm | |||
| Grossing = | |||
| Staging = | |||
| Site = [[ovary]] - see ''[[ovarian tumours]]'' | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = +/-malignancy elsewhere | |||
| Signs = +/-abdominal mass | |||
| Symptoms = +/-pain, +/-abdominal distension | |||
| Prevalence = | |||
| Bloodwork = serology suggestive of other primary, e.g. elevated [[CEA]] | |||
| Rads = adnexal mass/ovarian mass | |||
| Endoscopy = | |||
| Prognosis = poor | |||
| Other = | |||
| ClinDDx = ovarian primary | |||
| Tx = dependent on primary - often chemotherapy and radiation, occasionally de-bulking (surgery) | |||
}} | |||
An '''ovarian metastasis''' (also '''ovary with metastatic disease''' and '''metastatic ovarian disease''') is [[cancer]] in the [[ovary]] that arose elsewhere and spread to the ovary. | |||
==Generally== | ==Generally== | ||
* Mostly Muellerian origin (uterus, [[fallopian tube]]) or pelvic [[peritoneum]]. | * Mostly Muellerian origin ([[uterus]], [[fallopian tube]]) or pelvic [[peritoneum]]. | ||
Common extramuellerian metastatic tumours: | Common extramuellerian metastatic tumours: | ||
| Line 12: | Line 44: | ||
==Gross== | ==Gross== | ||
Features favouring metastatic mucinous carcinoma (from the [[GI tract]]) over primary ovarian mucinous carcinoma:<ref name=pmid18162780>{{Cite journal | last1 = Yemelyanova | first1 = AV. | last2 = Vang | first2 = R. | last3 = Judson | first3 = K. | last4 = Wu | first4 = LS. | last5 = Ronnett | first5 = BM. | title = Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification. | journal = Am J Surg Pathol | volume = 32 | issue = 1 | pages = 128-38 | month = Jan | year = 2008 | doi = 10.1097/PAS.0b013e3180690d2d | PMID = 18162780 }}</ref> | Features favouring metastatic mucinous carcinoma (from the [[GI tract]]) over primary ovarian mucinous carcinoma:<ref name=pmid18162780>{{Cite journal | last1 = Yemelyanova | first1 = AV. | last2 = Vang | first2 = R. | last3 = Judson | first3 = K. | last4 = Wu | first4 = LS. | last5 = Ronnett | first5 = BM. | title = Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification. | journal = Am J Surg Pathol | volume = 32 | issue = 1 | pages = 128-38 | month = Jan | year = 2008 | doi = 10.1097/PAS.0b013e3180690d2d | PMID = 18162780 }}</ref> | ||
*Bilaterality | *Bilaterality - both ovaries involved. | ||
*Small unilateral tumour size | *Small unilateral tumour size. | ||
**>13 cm | **<10 cm suggests metastasis. | ||
**>13 cm suggests ovarian primary. | |||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*Predominantly surface involvement and nodular at low power. | *Predominantly surface involvement and nodular at low power. | ||
*+/-[[Signet ring cell]]s (suggestive of GI or breast primary). | *+/-[[Signet ring cell]]s (suggestive of GI or breast primary). ‡ | ||
*[[Lymphovascular invasion]]. | *[[Lymphovascular invasion]]. | ||
=== | Note: | ||
*‡ ''Primary [[signet ring cell carcinoma]] of the ovary'' exists but is very rare.<ref name=pmid21611142>{{Cite journal | last1 = El-Safadi | first1 = S. | last2 = Stahl | first2 = U. | last3 = Tinneberg | first3 = HR. | last4 = Hackethal | first4 = A. | last5 = Muenstedt | first5 = K. | title = Primary signet ring cell mucinous ovarian carcinoma: a case report and literature review. | journal = Case Rep Oncol | volume = 3 | issue = 3 | pages = 451-7 | month = Sep | year = 2010 | doi = 10.1159/000323003 | PMID = 21611142 }}</ref> | |||
===Images=== | |||
====Breast carcinoma==== | |||
<gallery> | <gallery> | ||
Image:Adenocarcinoma_of_the_breast_metastatic_to_the_ovary_-_low_mag.jpg | Ovarian metastasis - low mag. (WC/ | Image:Adenocarcinoma_of_the_breast_metastatic_to_the_ovary_-_low_mag.jpg | Ovarian metastasis (breast) - low mag. (WC) | ||
</gallery> | |||
====Urothelial carcinoma==== | |||
<gallery> | |||
Image: Ovarian metastasis -- very low mag.jpg | Ovary metastasis (UCC) - very low mag. (WC) | |||
Image: Ovarian metastasis -- low mag.jpg | Ovary metastasis (UCC) - low mag. (WC) | |||
Image: Ovarian metastasis -- intermed mag.jpg | Ovary metastasis (UCC) - intermed. mag. (WC) | |||
Image: Ovarian metastasis - alt -- intermed mag.jpg | Ovary metastasis (UCC) - intermed. mag. (WC) | |||
</gallery> | </gallery> | ||
Latest revision as of 14:25, 28 January 2016
| Ovarian metastasis | |
|---|---|
| Diagnosis in short | |
 Ovary with a metastasis from breast carcinoma (left of image). H&E stain. | |
|
| |
| LM | predominantly surface involvement and nodular (especially at low power), +/-signet ring cells (suggestive of GI or breast primary), lymphovascular invasion |
| LM DDx | ovarian primary tumours - esp. ovarian mucinous carcinoma, serous carcinoma of the ovary, endometrioid carcinoma of the ovary |
| IHC | dependent on primary site |
| Gross | classically bilateral masses <10 cm |
| Site | ovary - see ovarian tumours |
|
| |
| Clinical history | +/-malignancy elsewhere |
| Signs | +/-abdominal mass |
| Symptoms | +/-pain, +/-abdominal distension |
| Blood work | serology suggestive of other primary, e.g. elevated CEA |
| Radiology | adnexal mass/ovarian mass |
| Prognosis | poor |
| Clin. DDx | ovarian primary |
| Treatment | dependent on primary - often chemotherapy and radiation, occasionally de-bulking (surgery) |
An ovarian metastasis (also ovary with metastatic disease and metastatic ovarian disease) is cancer in the ovary that arose elsewhere and spread to the ovary.
Generally
- Mostly Muellerian origin (uterus, fallopian tube) or pelvic peritoneum.
Common extramuellerian metastatic tumours:
- Breast.
- Gastrointestinal (GI) tract.
- Pseudomyxoma peritonei, usu. appendiceal origin.
- Krukenberg tumour = signet ring cell cancer with mucin production of GI origin.
Gross
Features favouring metastatic mucinous carcinoma (from the GI tract) over primary ovarian mucinous carcinoma:[1]
- Bilaterality - both ovaries involved.
- Small unilateral tumour size.
- <10 cm suggests metastasis.
- >13 cm suggests ovarian primary.
Microscopic
Features:
- Predominantly surface involvement and nodular at low power.
- +/-Signet ring cells (suggestive of GI or breast primary). ‡
- Lymphovascular invasion.
Note:
- ‡ Primary signet ring cell carcinoma of the ovary exists but is very rare.[2]
Images
Breast carcinoma
Ovarian metastasis (breast) - low mag. (WC)
Urothelial carcinoma
Ovary metastasis (UCC) - very low mag. (WC)
Ovary metastasis (UCC) - low mag. (WC)
Ovary metastasis (UCC) - intermed. mag. (WC)
Ovary metastasis (UCC) - intermed. mag. (WC)
IHC
Ovarian tumours:
- Dipeptidase 1 (DPEP1) +ve.[3]
- CK7 +ve.
See also
References
- ↑ Yemelyanova, AV.; Vang, R.; Judson, K.; Wu, LS.; Ronnett, BM. (Jan 2008). "Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification.". Am J Surg Pathol 32 (1): 128-38. doi:10.1097/PAS.0b013e3180690d2d. PMID 18162780.
- ↑ El-Safadi, S.; Stahl, U.; Tinneberg, HR.; Hackethal, A.; Muenstedt, K. (Sep 2010). "Primary signet ring cell mucinous ovarian carcinoma: a case report and literature review.". Case Rep Oncol 3 (3): 451-7. doi:10.1159/000323003. PMID 21611142.
- ↑ Okamoto, T.; Matsumura, N.; Mandai, M.; Oura, T.; Yamanishi, Y.; Horiuchi, A.; Hamanishi, J.; Baba, T. et al. (Feb 2011). "Distinguishing primary from secondary mucinous ovarian tumors: an algorithm using the novel marker DPEP1.". Mod Pathol 24 (2): 267-76. doi:10.1038/modpathol.2010.204. PMID 21076463.