Ovarian metastasis from nongynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience

Abstract

Background Metastasis to the ovary from nongynecologic organs accounts for 9% of all ovarian malignancies. Although the most common nongynecologic primary site of ovarian metastasis is the gastrointestinal tract, metastasis from other sites to the ovary is not uncommon. Differential diagnosis of primary and metastatic ovarian tumors is important; otherwise, appropriate treatment cannot be determined. Furthermore, an optimal treatment strategy for ovarian metastasis from nongynecologic primary sites still needs to be explored. Methods One hundred seventy-seven patients with ovarian metastasis from nongynecologic primary sites admitted to Peking Union Medical College Hospital between May 2005 and May 2018 were retrospectively evaluated. Results The mean age was 48 years (range, 18–83). Approximately 60% of patients were premenopausal women. The two most common nongynecologic primary sites of ovarian metastasis were the colorectum (68 cases) and stomach (61 cases). In addition to the most common symptoms of abdominal distension (39.0%), abdominal pain (37.9%), and ascites (27.7%), 18.1% of patients presented with abnormal uterine bleeding. Half of the patients who tested serum CA-125 preoperatively had elevated CA-125 levels within the range of 35 U/ml to 200 U/ml. More than 70% of synchronous ovarian metastases were preoperatively misdiagnosed as primary ovarian cancer. Of all included cases, 56.5% achieved optimal cytoreductive surgery (the diameter of the largest residual lesion < 2 cm). The overall 5-year survival rate and median survival time were 10% and 20 months, respectively. The primary site, optimal cytoreductive surgery, tumor differentiation, and postoperative adjuvant treatment were identified as prognostic indicators. Conclusions The colorectum and stomach are the most common nongynecologic primary sites of ovarian metastasis. Synchronous ovarian metastasis is easily misdiagnosed as primary ovarian cancer. Optimal cytoreductive surgery and postoperative adjuvant treatment can be performed to confer survival benefit in selected patients.

The etiology of adnexal masses in women with a history of non-gynaecological malignancy: recurrence, second, primary or none?

“…Despite the low overall rate of POCs, in those with a history of breast cancer presenting with a suspicious adnexal mass this was as high as 64%. A recent study that included one hundred and seventy-seven patients with ovarian metastasis from non-gynecological primary sites found that the colorectum (n=68) and stomach (n=61) were the two most common non-gynecological primary sites of ovarian metastasis ( 8 ). These authors also reported that more than 70% of synchronous ovarian metastases were misdiagnosed as POC prior to surgery.…”

The role of PET/CT in oncogynecology (literature review)

“…Вторичные опухоли яичников составляют примерно 10-30% всех злокачественных новообразований яичников [53]. Наиболее распространенной первичной локализацией в генитальной области являются тело и шейка матки, а негенитальные первичные опухоли происходят преимущественно из желудочно-кишечного тракта (толстая кишка, аппендикс) и молочной железы, включая опухоли Крукенберга [54].…”

G‐protein‐coupled estrogen receptor 1 promotes peritoneal metastasis of gastric cancer through nicotinamide adenine dinucleotide kinase 1‐mediated redox modulation

“…It is worth noting that stomach is the most common nongynecologic primary site of ovarian metastasis. 13 These led us to be interested in whether estrogen promotes peritoneal metastasis of gastric cancer. Sunyi Lee et al found that estrogen aggravates tumor growth in a diffuse gastric cancer xenograft model.…”

“…Generally, the incidence rate of gastric cancer is higher in males than in females. It is worth noting that stomach is the most common nongynecologic primary site of ovarian metastasis 13 . These led us to be interested in whether estrogen promotes peritoneal metastasis of gastric cancer.…”