Difference between revisions of "Ovarian metastasis"

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| Image      = Adenocarcinoma_of_the_breast_metastatic_to_the_ovary_-_low_mag.jpg
| Image      = Adenocarcinoma_of_the_breast_metastatic_to_the_ovary_-_low_mag.jpg
| Width      =
| Width      =
| Caption    = Ovary with a metastasis from breast carcinoma. [[H&E stain]].
| Caption    = Ovary with a metastasis from breast carcinoma (left of image). [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      = predominantly surface involvement and nodular (especially at low power), +/-signet ring cells (suggestive of GI or breast primary), [[lymphovascular invasion]]
| Micro      = predominantly surface involvement and nodular (especially at low power), +/-signet ring cells (suggestive of GI or breast primary), [[lymphovascular invasion]]
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==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:
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*Small unilateral tumour size.
*Small unilateral tumour size.
**<10 cm suggests metastasis.
**<10 cm suggests metastasis.
**>13 cm = ovarian primary.
**>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]].


===Image===
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/Nephron)
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

Common extramuellerian metastatic tumours:

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:

Note:

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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
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