Ovarian carcinomas, including secondary tumors: diagnostically challenging areas

Abstract

The differential diagnosis of ovarian carcinomas, including secondary tumors, remains a challenging task. Mucinous carcinomas of the ovary are rare and can be easily confused with metastatic mucinous carcinomas that may present clinically as a primary ovarian tumor. Most of these originate in the gastrointestinal tract and pancreas. International Federation of Gynecology and Obstetrics (FIGO) stage is the single most important prognostic factor, and stage I carcinomas have an excellent prognosis; FIGO stage is largely related to the histologic features of the ovarian tumors. Infiltrative stromal invasion proved to be biologically more aggressive than expansile invasion. Metastatic colon cancer is frequent and often simulates ovarian endometrioid adenocarcinoma. Although immunostains for cytokeratins 7 and 20 can be helpful in the differential diagnosis, they should always be interpreted in the light of all clinical information. Occasionally, endometrioid carcinomas may exhibit a microglandular pattern simulating sex cord-stromal tumors. However, typical endometrioid glands, squamous differentiation, or an adenofibroma component are each present in 75% of these tumors whereas immunostains for calretinin and alpha-inhibin are negative. Endometrioid carcinoma of the ovary is associated in 15-20% of the cases with carcinoma of the endometrium. Most of these tumors have a favorable outcome and they most likely represent independent primary carcinomas arising as a result of a Mü llerian field effect. Although the criteria for distinguishing metastatic from independent primary carcinomas rely mainly upon conventional clinicopathologic findings, loss of heterozygosity and gene mutation analyses can be helpful. Transitional cell carcinomas are distinguished from undifferentiated carcinomas by the presence of thick, undulating papillae with smooth luminal borders, microspaces, and tumor cells with distinctive 'urothelial' appearance. Krukenberg tumors are metastatic adenocarcinomas traditionally perceived as composed of mucin-filled signet-ring cells associated with a striking proliferation of the ovarian stroma but many variations on this pattern occur.

Recurrent small bowel obstruction in an elderly woman

“…Breast Ovarian metastatic tumors may arise from a variety of sources including the stomach, colon, appendix, breast, small intestine, biliary system (in particular the ampulla of Vater), carcinoid tumors from the gut, and hematological tumors. [5][6][7][8][9][10] Although the term Krukenberg tumor was originally applied to the presence of mucinous gastric carcinoma metastasizing to the ovaries, 11 the term is now often applied to any metastatic tumor to the ovaries. 12,13 Hematological malignancies may present as ovarian tumors and may involve both ovaries in 55% and the omentum and nodes in 69%.…”

Case Report Unsuspected and widespread colon cancer in a young woman

“…Epithelial ovarian tumours may pose diagnostic challenges in young females with liver metastatic adenocarcinoma, mainly if the pelvic ultrasound images are suggestive of a cystic ovarian tumour. Although primary ovarian cancers can mimic the characteristics of colon cancer as signet-ring cells and surface mucin, ovarian carcinomas are almost all CK7-positive, CK20-negative, and vimentin-positive 5 . With regards to lung cancers, one must clear if they are primary or secondary tumours; furthermore, pathological and morphological features of lung acinar adenocarcinoma may be similar to those of well-differentiated colon cancer.…”

Synchronous Cancers of the Ovary and Endometrium

“…One of the theories suggests that when tissues of same embryonic origin are subjected to hormonal exposure or to carcinogens, they develop synchronous malignancies [ 10 ]. The presence of estrogen receptors in these tissues indicate a hormonal fi eld effect which could lead to the development of simultaneous cancers in the endometrium and ovary.…”