Invasive breast carcinoma - IARC

Secondary tumours of the ovary
J. Prat
P. Morice
Definition
Malignant tumours that metastasize to
the ovary from extraovarian primary neoplasms.
Tumours that extend to the ovary
directly from adjacent organs or tissues
a re also included in this category.
However, most ovarian carcinomas associated
with uterine cancers of similar histological
type are independent primary
neoplasms. General features of ovarian
metastasis include: bilaterality, small
multinodular surface tumours, extensive
extraovarian spread, unusual patterns of
dissemination, unusual histological features,
blood vessel and lymphatic invasion
and a desmoplastic reaction.
Synonym
Metastatic tumours.
The term Krukenberg tumour refers to a
metastatic mucinous/signet-ring cell
adenocarcinoma of the ovaries which
typically originates from primary tumours
of the G.I. tract, most often colon and
stomach.
Epidemiology
Metastatic tumours to the ovary are common
and occur in approximately 30% of
women dying of cancer. Approximately
6-7% of all adnexal masses found during
physical examination are actually
metastatic ovarian tumours, frequently
unsuspected by gynaecologists {1587,
2605,2980}. The metastasis often masquerades
as a primary ovarian tumour
and may even be the initial manifestation
of the patient's cancer. Pathologists also
tend to mistake metastatic tumours for
primary ovarian neoplasms even after
histological examination. Carcinomas of
the colon, stomach, breast and
endometrium as well as lymphomas and
leukaemias account for the vast majority
of cases {3226}. Ovarian metastases are
associated with breast cancer in 32-38%
of cases, with colorectal cancer in 28-
35% of cases and with tumours of the
genital tract (endometrium, uterine
cervix, vagina, vulva) in 16% of cases. In
recent years attention has been drawn to
mucinous tumours of the appendix, pancreas
and biliary tract that often spread
to the ovary and closely simulate ovarian
mucinous borderline tumours or carcinomas
{590,1848,2406,3199,3200}.
Aetiology
The routes of tumour spread to the ovary
are variable. Lymphatic and haematogenous
metastasis to the ovaries is the
most common form of dissemination
{1587,2605,2980}. Direct extension is
also a common manner of spread from
adjacent tumours of the fallopian tube,
uterus and colorectum {3226}. Transtubal
spread provides an explanation for some
s u rface ovarian implants from uterine
cancers. Neoplasms may also reach the
ovary by the transperitoneal route from
abdominal organs, such as the appendix
{3199}. Embolic spread often produces
Table 2.09
Metastatic tumours to the ovary.
Clues to the diagnosis
1 - Bilaterality (mucinous and endometrioid-like)
2 - Small, superficial, multinodular tumours
3 - Vascular invasion
4 - Desmoplastic reaction
5 - Extensive, unusual extraovarian spread
6 - Unusual clinical history
multiple nodules within the substance of
the ovary and commonly is accompanied
by prominent intravascular nests of
tumour in the ovarian hilum, mesovarium
and mesosalpinx.
Clinical features
Signs and symptoms
Ovarian metastases can be discovered
in patients during follow-up after treatment
of a primary tumour, seredipitously
diagnosed during a surgical procedure
for treatment of an abdominal tumour or
fortuitously found at autopsy. The circumstances
leading to the discovery of these
metastatic lesions depends on the site of
the primary tumour {951,1802}. Ovarian
metastasis was detected before the
breast cancer in only 1.5% of cases
A
B
Fig. 2.130 Metastatic colonic adenocarcinoma of the ovaries. A The ovaries are replaced by bilateral, multinodular metastases. Note the additional leiomyomas of
the corpus uteri (centre). B This tumour shows a garland-like glandular pattern with focal segmental necrosis of glands and luminal necrotic debris.
C Immunohistochemical stain for carcinoembryonic antigen is strongly positive.
C
Secondary tumours of the ovary
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