Metastatic Intestinal Carcinomas Simulating Primary Ovarian Clear Cell Carcinoma and Secretory Endometrioid Carcinoma

Abstract

Five cases of ovarian metastases of intestinal adenocarcinomas that suggested the diagnosis of clear cell adenocarcinoma or the secretory variant of endometrioid carcinoma of the ovary are reported. Patient age ranged from 27 to 71 years at the time of diagnosis of the ovarian neoplasms. In four, the ovarian and intestinal tumors were discovered synchronously, and, in the fifth, the ovarian metastasis occurred 1 year after the intestinal primary was diagnosed. The ovarian tumors were unilateral in three patients and bilateral in two. They were up to 18 cm (mean, 12 cm) in maximum dimension and were characterized on microscopic evaluation by glands and cysts lined by cells whose most striking feature was abundant clear cytoplasm. In two cases, striking subnuclear or supranuclear vacuoles were present. An important clue to the diagnosis of metastatic intestinal adenocarcinoma was the presence in all cases of "dirty necrosis." The metastatic nature of the ovarian tumors was supported by the immunohistochemical findings. All tumors stained were strongly positive for carcinoembryonic antigen and cytokeratin 20 and failed to stain for CA125, whereas staining for HAM56 and cytokeratin 7 was absent or only focally positive in one case each. Three intestinal primary tumors involved the small bowel. Microscopic evaluation of the intestinal tumors in three cases and metastases in a fourth, in which the intestinal primary was not resected, showed the features of the uncommon clear cell variant of intestinal adenocarcinoma; the fifth was predominantly a conventional intestinal adenocarcinoma with only a focal clear cell component. Although intestinal adenocarcinomas metastatic in the ovary typically simulate endometrioid adenocarcinoma of the usual type or mucinous adenocarcinoma, they may mimic either primary clear cell adenocarcinoma or the secretory variant of endometrioid adenocarcinoma, particularly when the primary tumor is, even focally, the clear cell variant of intestinal adenocarcinoma.

Clear Cell Carcinoma of the Liver: A Comparative Immunohistochemical Study with Renal Clear Cell Carcinoma

“…None of the tumors were reactive with the alpha-fetoprotein immunostain, but we have found this to be the case in any HCC unless the serum level is elevated. Furthermore, in addition to liver and germ cell tumors, positive AFPs have been described in a few intestinal adenocarcinomas as well as in female genital tract tumors (17,20).…”

Ovarian carcinomas, including secondary tumors: diagnostically challenging areas

“…1 Rare adenocarcinomas metastatic from the intestine may contain cells with abundant clear cytoplasm simulating either clear cell adenocarcinoma or the secretory variant of endometrioid carcinoma. 30 Endometrioid adenocarcinomas simulating sex cord-stromal tumors Occasionally, endometrioid carcinomas contain solid areas punctuated by small rosette-like glands (microglandular pattern) simulating an adult granulosa cell tumor. 31 In other cases, a diffuse growth of cells in an endometrioid carcinoma may suggest the diffuse pattern of a granulosa cell tumor.…”

Colon metastasis 20 years after the removal of ovarian cancer: Report of a case

“…CA-125, cytokeratin 7, estrogen receptors, and progesterone receptors are generally positive in ovarian cancers, and CEA and cytokeratin 20 are generally positive in colorectal cancers. 13,14 In the present case, the colonic tumor was positive for cytokeratin 7, CA-125, and estrogen receptors, and negative for cytokeratin 20, CEA, and progesterone receptors. This pattern was consistent with an ovarian origin rather than a colonic one.…”