Primary mucinous ovarian tumors vs. ovarian metastases from gastrointestinal tract, pancreas and biliary tree: a review of current problematics

Abstract

Background Making the distinction between primary mucinous and metastatic ovarian tumors is often difficult, especially in tumors with a primary source from the gastrointestinal tract, pancreas and biliary tree. The aim of the following paper is to provide an overview of the problematics, with a focus on the possibilities of the differential diagnosis at the macroscopic, microscopic and immunohistochemical level. Main body The three main aspects of mucinous ovarian tumors are described in detail, including the comparison of the available diagnostic algorithms based on the evaluation of mostly macroscopic features, characterization of the spectrum of microscopic features, and a detailed analysis of the immunophenotype comparing 20 antibodies with the assessment of their statistical significance for differential diagnosis purposes. Specific features, including Krukenberg tumor and pseudomyxoma peritonei, are also discussed. Conclusion Despite the growing knowledge of the macroscopic and microscopic features of ovarian mucinous tumors and the availability of a wide range of immunohistochemical antibodies useful in this setting, there still remains a group of tumors which cannot be precisely classified without close clinical-pathological cooperation.

Isolated Ovarian Metastasis from Pancreatic Cancer Mimicking Primary Ovarian Neoplasia: Role of Molecular Analysis in Determining Diagnosis

“…Finally, there was also a focus suggestive of surface involvement in one section, another feature that would support the diagnosis of metastatic carcinoma. 3 , 5–7 …”

Metastatic Ovarian Mucinous Carcinoma Presenting as Ileocecal Adenocarcinoma: A Case Report

“…However, these techniques are insufficient to differentiate primary from metastatic ovarian mucinous tumors. Therefore, microscopic features and IHC assays can help classify tumors that have invaded the lower gastrointestinal tract [ 11 ]. Primary mucinous ovarian tumors express CK7 in 90% of the cases, mostly in a diffuse pattern, while CK20 is expressed in 65%-70%.…”

“…Primary mucinous ovarian tumors express CK7 in 90% of the cases, mostly in a diffuse pattern, while CK20 is expressed in 65%-70%. CK7+/CK20+ has been observed in 67%-74% [ 5 , 10 - 12 ], CK7+/CK20- in 26%, and CK7-/CK20+ in 7% of cases [ 11 , 13 ]. CDX2 positivity is found in 49%-64% of primary mucinous ovarian tumors; however, its expression has also been found in metastatic appendiceal, pancreaticobiliary, and gastric carcinomas [ 11 - 14 ].…”

“…CK7+/CK20+ has been observed in 67%-74% [ 5 , 10 - 12 ], CK7+/CK20- in 26%, and CK7-/CK20+ in 7% of cases [ 11 , 13 ]. CDX2 positivity is found in 49%-64% of primary mucinous ovarian tumors; however, its expression has also been found in metastatic appendiceal, pancreaticobiliary, and gastric carcinomas [ 11 - 14 ]. Therefore, when positive, it should be compared with markers like monoclonal CEA, ER, and synaptophysin, in conjunction with CK7 and CK20, in order to narrow the differential.…”

A combination of immunohistochemical markers, MUC1, MUC5AC, PAX8 and growth pattern for characterization of mucinous neoplasm of the ovary

“…There are several possible reasons for this failure: the histological similarity between borderline and carcinoma mucinous subtypes, metastasis of other cancers that mimic borderline or carcinoma mucinous subtypes, or insufficiently standardized grading guidelines. In particular, the expression of CK20, CK7, and CDX2 is similar for both primary and metastatic tumor groups 5. Currently, the distinction between those two entities is mainly represented by SATB2 and PAX8 6.…”